Open Access Case Report

Pyogenic Spondylitis: Case Report on Cervical Pyogenic Spondylitis

Morgan Ikponmwosa, Ferguson Ayemere Ehimen, Iboro Samuel Akpan, Adioha Kelechi Chinemerem, Eze Pedro Nnanna

Journal of Advances in Medicine and Medical Research, Page 159-164
DOI: 10.9734/jammr/2021/v33i1831066

Pyogenic spondylitis involves a broad spectrum of structures around the spine including the vertebra (vertebral osteomyelitis), discs (septic discitis) and epidural abscess. Symptoms may include fever, pain, sensory-motor deficits, and obtundation. Fever is a symptom, however, may not be common as it occurs in less than of patients. It may affect any aspect of the spine, with the cervical spine been the least affected. Magnetic resonance imaging (MRI) is critical for early diagnosis and extensively used for diagnosis. Our case presents a lady who was referred for an MRI of the neck following neck pain for over 3 months.

Open Access Case Report

The Mangement of Splenic Cysts in Children

M. Boughdir, S. Nechi, S. Bellila, W. Maamatou, L. Jarray, Y. Hellal, M. A. Sebai

Journal of Advances in Medicine and Medical Research, Page 188-195
DOI: 10.9734/jammr/2021/v33i1831070

Introduction: Tumors of the spleen are rare in children, but they present a wide range of diagnostic, histological and radiological appearance. Splenic cysts are far more common than solid lesions. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). They are most often asymptomatic. Diagnosis can usually be established with the clinical context and radiology (ultrasound, CT, MRI). Different options for the management of splenic cysts are available to the pediatric surgeon, ranging from simple monitoring to surgical excision. Minimally invasive surgical techniques and spleen conservative surgery have made splenic surgery less aggressive.

The aim of the study was to describe the clinical and paraclinical characteristics of splenic cysts in children, and to assess their management.

Patients and Methods: In a retrospective study within the pediatric surgery department in tunis, Tunisia, we have collected five children with a diagnosis of splenic cyst during the last decade. We specified for each patient the functional signs and physical examination data, ultrasound and CT were done for the patients, specifying the location and the size of the cysts. Hydatic serology was done when the parasitological origin was suggested. After surgical management and histological confirmation, the follow–up was based on clinical examination and abdominal ultrasound.

Results: They were three girls and two boys. The average age is ten and a half years. All patients were symptomatic with abdominal pain. The size of the cysts was significantly increased in all patients with an average of 11 cm. Surgery was indicated for all cases. Three patients had cystic resection and two had partial splenectomy. The histology objectified epithelial cyst for three patients and hydatid cyst of the spleen for the other two cases. The subsequent outcome was favorable for all patients with a current mean follow-up of three years.  

Conclusion: Splenic cysts are rare in children and their management is still controversial. In splenic cysts, imaging can give clues to the diagnosis, but it often requires pathological examination of the part. Resection should be as limited as possible in order to avoid the risk of total splenectomy.

Open Access Case Study

Erector Spinae Plane Block: A New Twinkling Star Ready To Create Wonders in Toddler’s Spine Surgeries - A Case Report

Kartik Sonawane, Akshay Rahurkar, Hrudini Dixit, Chelliah Sekar

Journal of Advances in Medicine and Medical Research, Page 51-56
DOI: 10.9734/jammr/2021/v33i1831053

Aims: The expanded horizon of the ultrasound-guided erector spinae plane block (ESPB) shows promising results in various surgeries involving the thoracic, abdominal, pelvic, joint, and spine regions. We aimed to administer ESPB in spine surgery of the early pediatric age group patient to reduce the overall requirement of the intraoperative general anesthetic drugs and postoperative opioids due to high analgesic demands.

Presentation of Case: We report the application of ultrasound-guided bilateral ESPB as multimodal analgesia (MMA) component in the spine surgery of the youngest (2-year old) age group.

Discussion: Spine surgeries, especially scoliosis surgeries, are associated with extensive surgical dissection, leading to significant postoperative nociception causing high analgesic demands and necessitating high opioid consumption. It further leads to opioid-related side effects, delay in discharge, late ambulation, and prolonged hospital stay.

The ESPB potentially helps in controlling polypharmacy by providing wide multisegmented analgesic coverage due to its multidirectional drug spread pattern. There are upcoming concerns regarding anesthesia-induced developmental neurotoxicity and the detrimental effect of general anesthesia in developing children. Such concerns can be addressed by cutting down the requirement of general anesthetic agents to a minimum level with the help of modalities like MMA incorporating regional analgesia (RA) as an adjunct.

Conclusion: The ESPB can be a safe and effective adjunct to the MMA in providing opioid-free optimal analgesia in spine surgery of the youngest population.

Open Access Case Study

Abdominal Tuberculosis – A Resemblance to Peritoneal Carcinomatosis

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 87-92
DOI: 10.9734/jammr/2021/v33i1831058

Introduction: Tuberculosis remains a global public health concern. Abdominal tuberculosis is an atypical presentation and since it is extrapulmonary it may delay the diagnosis and treatment of this condition. The case report describes a typical presentation of abdominal tuberculosis and highlights the difficulties which are encountered in the diagnosis of abdominal tuberculosis.

Presentation of case: A 56 year old gentleman admitted to hospital with a 1 week history of generalised abdominal pain associated with abdominal distention and vomiting. The chest-X-ray was unremarkable and the abdominal X-ray revealed air-fluid levels. Laboratory investigations revealed a high white cell count at 14,000µl. At laparotomy, multiple small whitish deposits in the greater omentum and on the bowel with a frozen abdomen was found. Biopsy of these whitish deposits showed histology of giant Langhans multinucleated cells with acid-fast bacilli and necrosis and a granulomatous inflammatory process. Anti-tuberculosis treatment was initiated using a combination of antibiotics and he made an uneventful recovery.

Discussion: The clinical abdominal TB presentations include acute, subacute or chronic disease. The chest-X-ray of our patient showed no evidence of pulmonary tuberculosis however this is not surprising as less than half of patients with abdominal TB have pulmonary tuberculosis. Ultrasound findings in abdominal TB include thickening of the wall of the ileum, caecum and colon and associated ascites. When malignancy cannot be ruled out with certainty then laparotomy is recommended with biopsy of any peritoneal lesions, omental lesions and a lymph node biopsy.

Conclusions: Judicious use of diagnostic procedures and a high index of suspicion may help in the timely diagnosis and treatment of abdominal tuberculosis. Biopsy of peritoneal/omental lesions and of a mesneteric lymph node is advisable to distinguish abdominal tuberculosis from peritoneal carcinomatosis.

Open Access Case Study

Inflamed Right Inguinal Appendix in a Sixty-four-year-old Man: A Case Report and Review of the Literature

Friday Emeakpor Ogbetere

Journal of Advances in Medicine and Medical Research, Page 176-180
DOI: 10.9734/jammr/2021/v33i1831068

The vermiform appendix has varied locations ranging from retrocaecal, pelvic, paracolic to pre-ileal and postileal. Inguinal appendix or Amyand’s hernia is an extremely rare occurrence with potentially fatal complications. Rarer still is the presence of an inflamed appendix in the inguinal canal in the elderly. Due to its rarity, the pathophysiology and risk factors of the condition are still unclear. Some theorize that it is secondary to a patent processus vaginalis or perhaps the presence of a fibrous band between the hernia sac and testes.  Reported herein is a 64-year-old man who presented with a painful irreducible right inguinal swelling. An incarcerated inguinal hernia with the hernia sac harbouring an inflamed vermiform appendix was discovered at surgery. Appendectomy and a primary suture repair of the hernia were carried out. The postoperative period was uneventful. Surgical management of inflamed inguinal appendix carries a risk of septic complications. It is pertinent that every surgeon performing a hernia repair must be aware of this condition and the appropriate treatment modalities.

Open Access Short Research Article

COVID-19 and Complicated Appendicitis: What is the Relationship?

B. I. Omolabake, A. F. Uko

Journal of Advances in Medicine and Medical Research, Page 22-26
DOI: 10.9734/jammr/2021/v33i1831050

Aims: The COVID-19 pandemic disrupted healthcare globally and several authors have observed a change in the presentation of acute appendicitis within the period. We have observed an upsurge in the presentation of complicated appendicitis within the first 4 weeks of 2021. We aim to compare our findings with a similar period prior to the COVID-19 pandemic.

Study design: Observational cohort study.

Place and duration of the study: Benue State University Teaching Hospital(BSUTH), Makurdi, Nigeria.

Methodology: We identified all patients that presented with appendicitis in our facility within the first four weeks of 2021 and retrieved their folders to ascertain our observation. We then retrieved the folders of patients who presented with appendicitis a year earlier when the pandemic was inexistent in our country. We compared the data between the two periods.

Results: In the period of the pandemic, we found an increased presentation of acute appendicitis, with most patients presenting as complicated appendicitis. There was an increased length of time between symptom onset and presentation, increase in operating time, postoperative complications, and length of hospital stay in the index period.

Conclusion: We conclude that there is an apparent increase in the presentation of complicated appendicitis with a resultant increase in post-operative complications and morbidity. However, these changes are likely a result of our response to the COVID-19 pandemic rather than the pathology of the SARS CoV-2 virus. We suggest that with the relaxation of movement restrictions and lockdowns in most places, and availability of COVID-19 vaccines, public enlightenment is necessary to encourage an early presentation of acute abdominal conditions with a view to decreasing morbidity.

Open Access Original Research Article

Clomiphene Stair-Step Protocol versus Traditional Protocol for Ovulation Induction in Polycystic Ovarian Syndrome Patients

Afaf S. Abd El Kader, Ayman S. Dawood, Ahmed T. Morsy, Hesham A. Salem

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/jammr/2021/v33i1831048

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in the reproductive period. It is one of the leading causes of infertility. The manifestations of PCOS include irregular or no menstrual periods, excess body weight and facial hair, acne, heavy periods and pelvic pain. The aim of this study is to determine the efficacy of stair step protocol compared to traditional protocol in ovulation induction of polycystic ovarian syndrome (PCOS) patients in terms of increasing rate of ovulation and pregnancy.

Methods: This study is non-blinded, multicenter, randomized controlled study and was carried out on infertile women attending the Fertility Clinic of Tanta University Hospital and Hurghada General Hospital. Two Hundred infertile patients with PCOS criteria and no other causes of infertility were enrolled according to inclusion and exclusion criteria.

Results: Student t test was used for the continuous variables (FSH, LH, Prolactin, AMH, TSH, Free testosterone). Student t test was used for the continuous variables (Endometrial thickness, Time to ovulate (d)). Chi-square analysis was used for the categorical variables (Ovulation rate, Pregnancy rate). Chi-square analysis was used for the categorical variables (Ovulation rate per cycle). There was no significant difference between two groups as regards mild and severe side effects.

Conclusions: This study concluded that stair step regimen improves the ovulation rate and pregnancy rate without any detrimental side effects compared to traditional regimen. It helps to know the sensitivity and resistance of an individual to clomiphene citrate much earlier and helps to plan ahead with alternative treatment for desired outcome. The advantage of shorter treatment period with similar side effects makes the stair step protocol suitable for use in routine clinical practice.

Open Access Original Research Article

Carriage Rate of Methicillin-Resistant Staphylococcus aureus among Workers in Critical Care Units of a Tertiary Hospital in Southwestern Nigeria

Oluwalana T. Oyekale, Adewale T. Olajide, Bola O. Ojo, Tosin O. Babalola, Oluwatoyin I. Oyekale

Journal of Advances in Medicine and Medical Research, Page 13-21
DOI: 10.9734/jammr/2021/v33i1831049

Background: Carriage of methicillin-resistant Staphylococcus aureus (MRSA) among Healthcare workers (HCWs) who serves as agent of pathogen transmission in hospital settings portends danger to critical care patients.

Aim: To determine the carriage rate of MRSA among HCWs in the critical care units of the hospital, to identify the factors associated with carriage, and to determine the antibiotic resistance pattern of isolates.

Study Design: A cross sectional descriptive study.

Materials and Methods: A total of 135 randomly selected consenting HCWs from critical care units were studied. Data on demographic characteristics and infection control practices were obtained from participants with the aid of questionnaire. Swabs of the anterior nares and hands of participants were cultured on oxacillin-containing mannitol salt agar (MSA), S. aureus was identified using convectional criteria and MRSA was identified by cefoxitin disc diffusion technique. Antibiotic susceptibility testing was carried out on all isolated MRSA.

Results: Carriage rate of MRSA was high (26.7%). Poor handwashing practices (P=.008) and presence of wound or skin infection (P=.003) were associated with higher isolation rate. None of the age, gender, profession and duration of unit stay of workers was associated with carriage rate of MRSA. Isolation rate was higher from the nose (18.5%) than the hands (8.1%). Isolates demonstrated high resistance to antibiotics: penicillin (100%), amoxicillin/clavulanate (66.7%), cefuroxime (61.1%), ceftriaxone (63.9%), erythromycin (55.6%). All isolates were sensitive to vancomycin.

Conclusion: Carriage rate of MRSA among critical care unit staff was high in this study. There is urgent need for formulation of infection control policies and enforcement, to prevent MRSA spread among critical care patients.

Open Access Original Research Article

Maternal Obesity and Its Adverse Effect on Maternal and Fetal Health

Zahraa M. Lutfy, Ayman S. Dawood, Adel E. Al gergawy, Mustafa Z. Mustafa

Journal of Advances in Medicine and Medical Research, Page 27-42
DOI: 10.9734/jammr/2021/v33i1831051

Background: The increasing prevalence of obesity worldwide has prompted the World Health Organization (WHO) to designate obesity as one of the most important global health threats. The epidemic is especially pronounced in women of reproductive age. Prepregnancy obesity is an independent risk factor for maternal and neonatal morbidity and mortality. The origin of this epidemic is unhealthy lifestyle – high energy and high-fat diet and physical inactivity. During periconceptual period and pregnancy, the composition of a woman’s diet is of particular importance, as it may influence the pregnancy, the delivery and the health of the mother and the infant later on, so an excessive gestational weight gain (GWG) is not recommended. The aim of our study is to clarify the complications related to excess prepregnancy body weight on maternal and fetal health.

Methods: Hundred obese pregnant women with BMI (30-40 Kg/m2) measured at first trimester were prospectively enrolled into this study. Routine blood pressures, random blood sugar measuring and ultrasonographic follow up are required during pregnancy for early detection of any complications related to maternal obesity and excessive gestational weight gain (GWG).

Results: cases statistically evaluated in these study were 100 pregnant females with mean age 27.34 years + 5 years SD and mean BMI 32.97 Kg/m2 + 2.92 Kg/m2 SD. Denoting in our study, the effect of maternal obesity om maternal and fetal health.

Conclusion: A causal relationship between the prepregnancy BMI and obstetric complications is proven. Weight management is important for every women of reproductive age. Thus, medical Practice must consider these complications by providing early detection and management to improve both maternal and neonatal outcome.

Open Access Original Research Article

Diagnostic Value of Fetal Thymus Size in Intrauterine Growth Restriction

Mohamed Mosaad Elshishiny, Mohamed Mohsen Elnamoury, Ayman Abd Elaziz Aldorf, Essmat Hamdy AboZeid

Journal of Advances in Medicine and Medical Research, Page 43-50
DOI: 10.9734/jammr/2021/v33i1831052

Background: Changes in thymus size and histopathology have been observed both in animal models of intrauterine growth restriction (IUGR). The aim of the present study was to evaluate the size of the fetal thymus by sonography in pregnancies with IUGR and to search for a possible relationship between a fetal thymus size and adverse perinatal outcomes.

Methods: This prospective observational study was carried out on 100 participants who were divided into two groups. Group A: Study group which include 50 patients with IUGR. Group B: Control group which Include 50 normal patients with appropriate gestational age. All patients were subjected to: History taking: (Personal, Obstetric History, Maternal Medical History) and trans-abdominal ultrasound.

Results: IUGR group show statistically significant decrease in the estimate of fetal weight (EFW) compared to the control group (P<0.05). Doppler study of umbilical artery shows significant increase of (pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) in IUGR group when compared to control group. Doppler study of middle cerebral artery (MCA) shows significant increase in (RI, SD) in IUGR group when compared to control group while PI doesn’t show significant difference between two groups.  Thymus size decrease in IUGR group when compared to the control group. IUGR group had low survival and lower APGR Score when compared to the control group. Correlation between thymus size with the studied doppler parameters and pregnancy outcome in the current study. Umbilical Doppler RI, PI and SD showed statistically significance in this study (P<0.05) and this means that the blood flow in the umbilical arterial (UA) is important for the fetus. As regard the MCA RI and SD Doppler, they show statistically significance in this study (P<0.05) while the MCA PI Doppler did not show any statistically significance in this study (P>0.05).

Conclusions: IUGR is associated with small thymus and small fetal thymus may be an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

Open Access Original Research Article

Clinico Haematological Profile in Paediatric Patients with Bicytopenia and Pancytopenia in a Tertiary Care Referral Centre of North India

Pankaj Katoch, Vipin Roach, Surinder Singh

Journal of Advances in Medicine and Medical Research, Page 57-63
DOI: 10.9734/jammr/2021/v33i1831054

Background: Bicytopenia and Pancytopenia are relatively common presentations in adults as compared to paediatric patients.  Clinical features present in different manifestations in children with Pancytopenia/Bicytopenia, which can range from bone marrow suppression temporarily to marrow infiltration by life-threatening malignancies.

Aim: To study the clinical and haematological profile in the paediatric age group withCytopenias. The study aims to analyze the severity of hematological findings as per causative factors in patients with Pancytopenia and Bicytopenia.

Methods: Prospective Observational Study conducted in the Department of Paediatrics in Dr.RPGMC Tanda Himachal Pradesh (INDIA). The study included all patients except those falling in the exclusion criteria.It was performed after oral and written informed consent.A total of 50 children admitted with bicytopenia and pancytopenia were enrolled from March 2013 to March 2014.

Results: Infection was the commonest etiology observed in 22(44%) patients with bicytopenia and pancytopenia. Bicytopenia was seen in 14 (20%) and pancytopenia in 8 (16%) cases with infection. Scrub typhus was the commonest Infection seen in 18(32%).Leukaemia was notedin 11(22%) cases.

Conclusions: The commonest age group affected was 11-15 years with female domination with a Male: Female ratio of 0.78:1. The commonest symptom was fever 37(74%)  then generalized weakness in 29 (58%) cases.Pallor was the most common sign in 43(86%) followed by Hepatomegaly 32(64%), Lymphadenopathy 30(60%), and Splenomeagly in 29 (58%) patients.  Infection was the commonest etiology followed by leukemia and megaloblastic anaemia. Scrub typhus was the commonest infection encountered in the present study.

Open Access Original Research Article

Vitamin D Level in Predialysis Chronic Kidney Disease Patients Stage 3 to 5 and Predictors of its Deficiency

Mohamed G. Mohamed, Hanaa I. Okda, Hossam A. Hodeib, Mostafa T. Gabr

Journal of Advances in Medicine and Medical Research, Page 64-72
DOI: 10.9734/jammr/2021/v33i1831055

Background: Vitamin D deficiency is commonly encountered in patients with chronic kidney disease (CKD) with or without undergoing dialysis. This study was conducted to assess vitamin D level in patients diagnosed with predialysis CKD stage 3 – 5, and to determine the predictors of its deficiency in such patients.

Materials and Methods: This cross-sectional study included 75 patients who were divided into three equal groups of CKD-3, CKD-4 and CKD-5. All cases were subjected to detailed history taking, physical examination and measurement of estimated glomerular filtration rate (eGFR) according to Cockcroft-Gault formula. In addition, laboratory investigations included CBC, renal function tests, serum ferritin, intact parathyroid hormone (iPTH) and vitamin D level.

Results: Patient demographics and other co-morbidities were comparable among the three groups. Serum vitamin D had mean values of 24.84, 20.52 and 11.24 ng/ml in patients with stages III, IV and V respectively, with significant difference between the three groups. Vitamin D deficiency was more common in CKD-5 cases. On the contrary, serum parathyroid hormone and ferritin were significantly higher levels, in patients with higher stages. There was statistically significant positive correlation of serumvitamin D with eGFR, Hb, calcium and albumin. On the other hand, serum vitamin D was negatively correlated with phosphate, PTH, urea andcreatinine.

Conclusion: It is evident that higher stages of CKD are associated with more vitamin D deficiency.

Open Access Original Research Article

Adherence to COVID-19 Mitigation Measures among Kilifi and Mombasa Residents - An Observational Study in Coastal Kenya

Judy Mwai, Ismail Ahmed, Jarim Omogi, Mohamed Abdi, Diana Nyole, Lydia Kaduka, Joseph Mutai, Philip Ndemwa

Journal of Advances in Medicine and Medical Research, Page 73-80
DOI: 10.9734/jammr/2021/v33i1831056

Aim: Corona Virus Disease-19 (COVID-19) pandemic led countries into engaging public health guidelines as a strategy towards preventing infections. Hand washing, social distancing and masking remains key measures for infection control and prevention of the COVID-19. Strict adherence to public health infection control and prevention protocols is necessary to contain the spread at the community stage of the virus. National and County governments in Kenya directed efforts and resources in implementing numerous infection control and prevention measures in public places and institutions. The study assessed adherence to water, sanitation and hygiene (WASH) guidelines among the residents of Kilifi and Mombasa County in combating COVID-19 infections.

Methodology: A cross sectional study was conducted between 25th November and 4th December 2020 in ten sub-counties in Mombasa and Kilifi counties, Kenya. Data was collected using Open Data Kit (ODK) mobile application.

Results: Forty observations were done in Kilifi (45 percent) and Mombasa (55.0 percent). More than a third (37.5 percent) of the observations were done at the household level, followed by public buildings (30.0 percent), market/shopping centers (30.0 percent) and bus terminus (2.5 percent). More than half of the occupants in both Kilifi 55.6 percent and Mombasa 68.2 percent observed physical distancing of 1.5 meters, however, low screening of temperature at the entrance was noted. The general observation shows only 55.6 percent of the premises visited had a hand-washing station in Kilifi while 68.2 percent in Mombasa County. Most of the hand washing stations had running water and people did proper handwashing in both Counties. Only 30.0 percent of the hand station at Kilifi County had soaps.

Conclusion: COVID – 19 will continue to pose serious public health challenges as many premises still don’t adhere to some of the guidelines. Multi-sectoral feasible approaches towards ensuring further adherence on all the public health guidelines should be given priority to control and prevent COVID-19 infection

Open Access Original Research Article

Study of Plasminogen Activator Inhibitor-1 (PAI-1) as Prognostic Marker in Sepsis

Amal Abdelaziz Abdellatif Elnomany, Hossam Abd El Mohsein Hodeib, Ghada Fouad Elbaradey, Mohammad Abdelrahman Sweilam

Journal of Advances in Medicine and Medical Research, Page 81-86
DOI: 10.9734/jammr/2021/v33i1831057

Background: Sepsis is an unorganized host response to infection that is manifested by the failure of organs and DIC and systemic coagulation due to failure of Plasmin as an important fibrin lytic protein that is regulated by plasminogen activators and inhibitors. Our theory is that elevated PAI-1 may have a role in multi-system organ failure in patients with septicemia and systemic coagulopathy.

Aim: to evaluate plasminogen activator inhibitor-1 as a prognostic factor in patients with septicemia and DIC.

Patients and Methods: 60 cases with septicemia and in shock, in addition to 20 healthy individuals. Cases were selected from surgical ICU, Tanta University hospitals. Normal healthy subjects were matched by age and gender with the patients' group.

Results: Respiratory system and urinary tract infections, were the most common infections and high SOFA and APACHE scores in the selected cases.  The hematological findings in septic patients are anemia, thrombocytopenia, and leukocytosis. There was a significant increase in urea, creatinine, SGOT, SGPT levels, and CRP in patient groups. Higher levels of PAI-1 in cases suffering sepsis. An increased mortality rate after 28 days of follow-up was noticeable in cases with established septic shock compared to other patient groups in Tanta university surgical intensive care. We found a direct correlation between PAI-1and SOFA, APACHE, bilirubin, creatinine, PT, APTT, and Procalcitonin.

Conclusions: PAI-1 level has a prognostic value in cases with infections or septicemia presented to our emergency center.

Open Access Original Research Article

Asymmetric Dimethyl Arginine Level in Children with Sickle Cell Disease: A Cross Sectional Study

Seham Fathy Khedr, Mohamed Hosny El Bradaey, Hala Mohamed Nagy, Mohamed Ramadan El-Shanshory, Eslam Elhawary

Journal of Advances in Medicine and Medical Research, Page 93-98
DOI: 10.9734/jammr/2021/v33i1831059

Background: Sickle cell disease (SCD) consists of a group of hemoglobinopathies in which individuals inherit hemoglobin variants derived from single point mutations. Asymmetric dimethylarginine (ADMA) contributes to limiting Nitric Oxide (NO)  bioavailability in SCD. The aim of the present study was to assess the level of the Asymmetric Dimethyl Arginine in children with sickle cell.

Methods: This cohort cross-sectional study was carried out on 60 children which were divided in to 3 equal groups. Group I: SCD children with sickle retinopathy. Group II: SCD children without retinopathy. Group III: healthy control children who were selected from the outpatient clinic.

Results: There was a significant increase in ADMA level among participants withSCD. There was a positive significant correlation between ADMA  level and family history as well as the  incidence of hepatomegaly. There was no significant correlation between ADMA level and demographic and laboratory parameters except LDH.

Conclusions: The level of ADMA is elevated in children with sickle cell anemia. High plasma ADMA level is a risk for hepatomegaly in children with sickle cell anemia.

Open Access Original Research Article

Spectrum of Bacterial Co-Infections of the Lower Respiratory Tract in COVID 19 Patients Admitted to the ICU of a Tertiary Care Hospital

Shoaib Khan, Asifa Nazir, Humaira Bashir, Umara Amin

Journal of Advances in Medicine and Medical Research, Page 99-109
DOI: 10.9734/jammr/2021/v33i1831060

Aims: We aimed to evaluate the burden of bacterial co-infections in patients with COVID-19 and to ensure judicious use of antibiotics.

Study Design: Hospital based, cross sectional study.

Place and Duration of Study: Postgraduate department of Microbiology, Government Medical College, Srinagar, and associated hospitals, between July 2020 and February 2021.

Methodology: A total of 70 patients diagnosed with COVID-19 by RT PCR of nasopharyngeal/oropharyngeal samples were included in the study. Lower respiratory specimen like endotracheal aspirate (ETA), sputum, and bronchoalveolar lavage (BAL) from COVID-19 patients admitted in the ICU were collected as per standard protocol and subjected to quantitative cultures in the laboratory. Antimicrobial susceptibility testing was carried out in line with CLSI recommendations.

Results: Of the 70 lower respiratory tract specimens (Endotracheal aspirate n=53, sputum n=15, and Bronchoalveolar lavage n=02) taken from RT-PCR confirmed COVID-19 patients, 51 (72.9%) showed microbiological evidence of bacterial infection by culture positivity. 28/51 (55%) were males and 23/51 (45%) were females, mean age was 54 years (range= 16-85 years). Majority of the organisms recovered (n=51, 83%) were Gram-negative bacilli, among which Acinetobacter spp. (n=27, 53%) followed by Klebsiella pneumoniae (n=06, 12%) were the most common. Among Gram positive organisms, methicillin resistant Staphylococcus aureus and Enterococcus sp were most commonly isolated.

Conclusion: It is evident from our study that superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus is of serious concern. Timely treatment of these infections is pivotal to decrease the morbidity and mortality rates in COVID-19-infected patients.

Open Access Original Research Article

Vacuum Extractor Versus Manual Head Extraction During Cesarean Section

Shahenda H. Basha, Doaa N. Shatat, Adel E. Elgergawy, Mohsen M. Elnamoury

Journal of Advances in Medicine and Medical Research, Page 110-119
DOI: 10.9734/jammr/2021/v33i1831061

Background: For multifactorial reasons, the rate of cesarean deliveries increased clearly over a decade; decreased in vaginal births after cesarean (VBAC), multiple gestation, maternal obesity, pre-term labor, gestational diabetes or hypertension, increased number of high-risk expectant mothers and the obstetrical medico-legal environment. Delivering the fetal head at cesarean section can also be a lengthy operation and can result in maternal or fetal Complications. The vacuum extractor allows for the application of traction on the fetal head. In this study we aim to compare the safety (for mother and infant) and efficacy of delivery of the fetal head in cesarean section using vacuum extractor with the manual extraction.

Methods: This study was conducted on 60 pregnant women undergoing cesarean section. All patients were between 37 and 42 weeks of pregnancy with signs of healthy fetus and were divided into 2 groups; Group I- 30 patients subjected to vacuum extraction at the cesarean section, Group II- 30 patients subjected to the conventional cesarean method.

The result: The BMI of women in group I was 27.90 ± 0.96 and in group II was 28.0 ± 0.98. The gestational age of the babies in Group I and II were 39.0 ± 1.02 and 39.0 ± 0.98 weeks. U-D interval for Group I and Group II were 48.40 ± 17.63 and 73.87 ± 16.76 days respectively. The estimated blood loss in group I and group II were 478.0 ± 59.62 and 464.7 ± 52.57 respectively. The birth weight of the babies delivered in Group I and Group II were 4253.33 ± 118.72 and 4246.67 ± 135.58 KG respectively. The five minutes Apgar score for Group I and Group II were 8.50 ± 0.68 and 8.57 ± 0.57.

Conclusion: The use of the vacuum extractor at cesarean section may be a safe and effective method to facilitate delivery of the large fetal head and cesarean section delivery can be simplified by this technique.

Open Access Original Research Article

Evaluation of the Efficacy of Excimer Light 308 nm Wavelength Versus Low Level Laser in Treatment of Alopecia Areata

Rania Abdelfatah Ali Elnagar, Doaa Waseem Nada, Arwa Mohammad Hassan, Doaa Salah Hegab

Journal of Advances in Medicine and Medical Research, Page 120-129
DOI: 10.9734/jammr/2021/v33i1831062

Background: Alopecia areata (AA) is a non-scaring alopecia which can affect any body hairy area. Excimer light 308 nm is a UVB irradiation with immunosuppressive effects. Low level light therapy (LLLT) emits low energy visible and infrared irradiation to modulate biological processes in cell. This study aimed to evaluate efficacy and safety  of excimer light 308 nm versus LLLT in treatment of AA.

Methods: Thirty patients with multilocular AA of the scalp were collected after excluding those with alopecia totalis, universalis, AA in other body sites than scalp, those with other systemic or dermatological diseases, those received topical therapy in the last 2 weeks or systemic therapy for AA in the last three months, pregnant and lactating females. Patients were distributed into two equal groups; group A was treated by excimer lamp and group B was treated by LLLT. Sessions were repeated twice weekly for 3 months and patients were followed for 3 months. Treatment efficacy was evaluated by severity of alopecia tool score (SALT score) and Dermoscopy; at baseline, at end of sessions and at follow up.

Results: A statistically significant improvement was detected in treated patches of both groups than control patches at end of sessions and only in group A at follow up. There was no statistically significant difference between both groups according to short vellus hair and regrowing hair at end of sessions and at follow up in dermoscopy. Side effects reported were minimal and transient in both groups.

Conclusion: Both excimer light and LLLT are safe and effective in treatment of AA. Apart from its relatively higher cost, Excimer light induced better and more sustained improvement than LLLT.

Open Access Original Research Article

Comparative Study between Patients with Hyperemesis Gravidarum and Normal Pregnancy Regarding Presence of Helicobacter Pylori Antibodies

Nada S. Abdul Aleem, Raghda A. El-Dakhakhni, Hesham M. Borg, Sahar M. Hazzaa, Nagwa I. Aglaan

Journal of Advances in Medicine and Medical Research, Page 130-142
DOI: 10.9734/jammr/2021/v33i1831063

Background: The severe form of nausea and vomiting of pregnancy called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Helicobacter pylori (H. pylori) is a prevalent gram-negative flagellated spiral bacterium that colonizes the stomach of half of the world’s population. Researchers have hypothesized that maternal hormonal and immunological changes during pregnancy that prevent allogenic rejection of fetus reactivates the bacterium. Aim of the work is to compare between patients with hyperemesis gravidarum and normal pregnancy regarding presence of Helicobacter pylori antibodies for proper management.

Materials and Methods: A case-control study was carried out on ninety pregnant women at 5-15 weeks of gestation, thirty pregnant females with single living fetus complaining of HG (Group A), Thirty pregnant females who were multiple pregnancy and/or trophoblastic disorders complaining of HG (Group B) and Thirty pregnant females with normal pregnancy (Group C). Serum test for H. pylori IgG antibody titer was done for all patients and controls using enzyme immunoassay-based kit.

Results: H. pylori were noted in 32 hyperemetic cases and 6 control subjects. The presence of H. pylori increased the risk of HG more than two fold (OR = 2.923, 95% CI: 1.326-6.446, P < 0.05).

Conclusion: There is powerful correlation between H. pylori and hyperemesis gravidarum which proved in single, multiple pregnancy and/or trophoblastic disorders.

Open Access Original Research Article

Clinical Outcomes in Patients with Hemorrhoids Treated by Finger Guided Hemorrhoidal Artery Ligation with Laser Hemorrhoidoplasty: A Retrospective Cohort Study

Kamal Gupta, Niranjan Agarwal, Kushal Mital

Journal of Advances in Medicine and Medical Research, Page 143-152
DOI: 10.9734/jammr/2021/v33i1831064

Background: Hemorrhoids are the most common anorectal disease. In Finger guided Hemorrhoidal Artery Ligation (FGHAL), the branches of Superior Hemorrhoidal Artery (SHA) are ligated after palpating the arteries with finger 2-3 cm above dentate line instead of using a doppler as in Doppler-guided Hemorrhoidal Artery Ligation (DGHAL). The procedure is followed by Laser Hemorrhoidoplasty (LHP), a minimally invasive technique.

Methods: We conducted the study to retrospectively analyze the clinical outcomes of FGHAL with LHP for surgical management in a patient cohort with hemorrhoids in routine clinical practice. We retrospectively collected and analyzed the data from hospital records of patients treated with FGHAL with LHP for their hemorrhoid disease (HD) from March 2017– March 2020 to understand the impact on pain, bleeding, and resolution of symptoms.

Results: The study included a total of 346 patients within 27 to 75 years of age. The presenting features were bleeding (93%), pain (89%), and prolapsed hemorrhoids (69%). Most patients had grade II hemorrhoids (60.7%). Patients reported no spontaneous bleeding after surgery; 225 patients (65%) experienced post-defecatory bleeding the day one after surgery and 98 patients (28.3%) on postoperative day 3. Patients did not report any bleeding after the 7th postoperative day. 90.2% had completely resolved symptoms 6-months after surgery. The average VAS score at 6h,12h,24h,48h and 72h after surgery were 3,2.2,1.3,0.4 and 0.1 respectively.

Conclusion: FGHAL is a cost-effective alternative to DGHAL. FGHAL, followed by the LHP technique, provides a very low pain and discomfort with minimal need for analgesics and wound care, electing it among the procedures suitable for HD. The method is a cost-effective alternative to DGHAL.

Open Access Original Research Article

The Impact of Resting Heart Rate and Hypertension on the Prevalence of Stroke in Sudanese Adults: A Population- Based Cross Sectional Study

D. A. Hassan, M. I. Elamin, M. Elamin, H. M. Beheiry, A. A. Abdalla, N. A. Fahal, S. A. Medani, A. B. Musa, I. A. Ali

Journal of Advances in Medicine and Medical Research, Page 165-175
DOI: 10.9734/jammr/2021/v33i1831067

Aims: To investigate the effect of elevated resting heart rate (RHR), hypertension (HTN) and associated risk factors on the prevalence of stroke among Sudanese adults. 

Study Design: This is a cross-sectional study based on a survey conducted by Sudanese society of hypertension during the May Month of Measurement (MMM), 2018 campaign.

Methods: A total of 12281 respondents (mean age: 32.5±14.5 years, 49% men) were included. Structured questionnaires of demographic data, and self-reported medical history were filled by all respondents and analyzed.  Blood pressure and RHR were measured using an Omron BP monitor. Participants were divided into two main cohorts: normotensive (n=9497, 77.3%) and hypertensive (n=2784, 22.7%) participants. Each cohort was then segregated into three sub-cohorts using RHR tertiles (T1: <79 bpm; T2: RHR: 79 to 100 bpm; and T3:>100 bpm).

Results: Multivariate logistic regression analyses were performed to assess the individual and combined effect of RHR and HTN on prevalence of stroke. Hypertensive patients were more likely to develop stroke compared to normotensive participants (OR= 2. 968, 95% CI 2.028-4.345). Within the hypertensive cohort, RHR T3 participants had a significantly increased risk of stroke compared to RHR T1-T2 combined (OR= 2.35, 95% CI1.043-5.323). Individuals of RHR T3 sub-cohort were more likely to be younger, leaner and displayed significantly higher level of both systolic & diastolic blood pressure compared to RHR T1 and T2 groups. Diabetes Mellitus and smoking increased the odds of stroke among both normotensives (OR (95% CI):5.6 (2.24- 14.09), 3.17 (1.71-6.08 respectively), and hypertensives (OR (95% CI): 4.40 (2.26-8.58), 2.03 (0.95-4.32) respectively). Female gender and older age also increases the odds of stroke among hypertensives (OR (95% CI): 1.85 (1.00- 3.45) and 2.00 (1.02- 4.17) respectively.  

In conclusion, this study demonstrated that HTN was an independent risk factor of stroke. The effect of elevated RHR on stroke was only prominent when joined to high blood pressure. Prevalence of tachycardia was higher among the young participants which make them more prone to stroke if the condition is associated with HTN. Our results highlight the importance of addressing elevated RHR to reduce the risk of stroke particularly among hypertensive patients.  

Open Access Original Research Article

Study of YKL-40 Expression in Chronic Plaque Psoriasis: Case Controlled Study

Ghada Abd EL-Maksoud EL-Setiha, Tarek El-Sayed Amin, Dareen Abd El-Aziz Mohammed, Yomna Mazid El-Hamd Neinaa

Journal of Advances in Medicine and Medical Research, Page 181-187
DOI: 10.9734/jammr/2021/v33i1831069

Background: Psoriasis is a common inflammatory skin disorder. The typical cutaneous lesions are papules and plaques covered with silvery scales distributed mainly on extensor aspects of extremities. The course and progression of the disease are unpredictable and vary in each patient. YKL-40 is a new inflammatory biomarker which may be involved the pathogenesis of the disease.

Objective: The aim of this study was to study YKL-40 expression in patients with psoriasis to evaluate its possible role in the pathogenesis of psoriasis.

Patients and Methods: This study included 30 patients with chronic plaque psoriasis and 10 healthy individuals of matched age and sex served as a control group. Punch biopsies of four mm were taken from the skin of psoriatic patients as well as from corresponding sites of control subjects. All specimens were examined by both hematoxylin and eosin stain and anti-YKL-40 stain.

Results: The intensity of YKL-40 expression was upregulated in both epidermis and dermis of psoriatic skin in comparison with normal skin of control subjects. YKL-40 expression in psoriatic skin showed significant positive correlation with Psoriasis Area and Severity Index (PASI) score.

Conclusion: YKL-40 involved in the pathogenesis of psoriasis manifested by its up-regulation in skin of psoriatic patients group in comparison to control group.

Open Access Original Research Article

Communication and Interaction in Haemophilia-Centred Social Media Communities in Turkey

Serra Sezgin, Mehmet Can Uğur

Journal of Advances in Medicine and Medical Research, Page 208-214
DOI: 10.9734/jammr/2021/v33i1831071

In rare diseases like haemophilia, access to information and experience as well as social and psychological support from social and scientific environments, especially from one’s peers and family, is important as the treatment itself. The development of social networks with the advance of communication technologies may provide health benefits for establishing and strengthening a support system. Focusing on communication and interaction in haemophilia-centred Facebook communities in Turkey, this study aims to analyse the roles and functions of such online communities in sharing and mitigating the health problems of haemophilic individuals and offering them social and psychological support. Accordingly, out of the 25 Facebook communities with Turkish content, all 10 active and open-access communities were included in the research sample and analysed through discourse analysis. The research discloses that there are discursive and functional differences in online communities established by individuals and institutions. Whereas the pages managed by organizations include more informative content with little interaction, the individual pages play a more affective role in the daily lives of haemophilic individuals, resulting in a strong network of solidarity. Therefore, the discourse on online communities were classified into two main categories, namely information exchange and emotional support. The current research on Turkey reveals the role of online communities in haemophilic individuals’ access to information on haemophilia and its treatment as well as social and psychological support. Moreover, the current research also provides room for discussion on how these online communities can better contribute to solidarity between haemophilic individuals, families, and health professionals.

Open Access Original Research Article

Awareness on Risk Factors of Oropharyngeal Cancer and Practice of Oral Sex among Students in Kinshasa City: A Pilot Study

Nyimi Bushabu Fidele, Sekele Marob Ndjock Patrick, Ramazani Haruna, Kalala Kazadi, Sekele Isourady Bourley Jean Paul, Mantshumba Milolo Augustin

Journal of Advances in Medicine and Medical Research, Page 196-207
DOI: 10.9734/jammr/2021/v33i1831072

Aims: The present study aimed to estimate the occurrence of oral sex, and the awareness of risk factors of Oropharyngeal cancer to prevent human papillomavirus (HPV)-associated oropharyngeal cancer.

Study design:  A prospective cross-sectional analysis was conducted using the 2019 Institut de Technique Medical de Kinshasa (ISTM-KIN) Interview Survey, Democratic Republic of Congo (DRC).

Place and Duration of Study: Participants were enrolled from March 2019 through April of the same year in the Democratic Republic of Congo (DRC), Kinshasa City.

Methodology: Eligibility criteria included both men and women aged 15 to 45 years, enrolled in an educational program, and accepted voluntarily to respondent the survey.  Demographic data, history of sexual behavior, initiation times, and knowledge about risk factors of oropharyngeal cancer were evaluated. Differences between groups of sexual behavior were tested by chi-square tests and ANOVA test at significant level of 5%.

Results:  Out of 1,196 participants, 412 (34.4%) were males and 784 (65.6%) females with an average (±SD) age of 20±2.4 years. A total of 964 respondents reported a history of sexually behavior (81%), of that, 53.1% had performed oral sex, 35.4% had vaginal sex and11.5% had practiced sodomy. Oral sex was the first sexual activity practiced with a significant difference among sexual behavior (P= .003). The respondents knew that oral sex is a risk factor for OPC (51.5%; n=616).     

Conclusion: Oral sex is the first sexual activity performed by students of Kinshasa Nursing School. Therefore, the education program to avoid the risk of HPV-associated oropharyngeal cancers may be necessary.

Open Access Review Article

Management of Arterial Complications in Patients with Inadvertent Arterial Injection

Ahmed M. Badway, Hassan A. Hassan, Mohamed F. Motwaly, Ahmed M. Ismail

Journal of Advances in Medicine and Medical Research, Page 153-158
DOI: 10.9734/jammr/2021/v33i1831065

Aim: The aim of this study is to assess complications in inadvertent arterial injection and their management.

Methods: From June 2018 to May 2020 in Tanta University Hospitals vascular and endovascular surgery department, this study was conducted on 30 patients with inadvertent intra-arterial drug injection complications, including femoral artery pseudoaneurysm, acute ischemia, and compartment syndrome. In 20 patients with femoral artery pseudoaneurysm, proximal control to external iliac artery and assessment of the vascularity was done intra-operatively for distal arterial Doppler flow. If the distal arterial flow was present, ligation of the common femoral artery was done, While if it was absent, iliofemoral bypass was done. Brachio-ulnar bypass was done for brachial artery pseudoaneurysm. Fasciotomy was done for compartment syndrome.

Results: The mean age of patients was 27.4 years ranged from 1 year to 64 years. The femoral artery was affected in 20 cases. The brachial artery was involved in 6 cases, radial artery in 2 cases, and ulnar artery in 2 cases. In 20 patients, ligations of the common femoral artery CFA with debridement of necrotic were done for all cases. Twelve patients had good Doppler flow, eight patients had no Doppler flow, and iliofemoral bypass was done. In the upper limb cases, one case presented by severe edema in hand necessitating fasciotomy. Four cases presented with fixed color changes and gangrene in fingers after one brachial, one radial, and two ulnar arteries injections and required minor amputation. Two cases were presented with neglected ischemia and extensive infection, and above the elbow, amputation was done. In three cases with brachial pseudoaneurysm, we ligated the brachial artery, and no bypass was done with the preserved distal flow in one case; in the other two cases of brachial artery pseudoaneurysm, we did brachio-ulnar bypass.

Conclusion: Inadvertent IA injection of medications has no appropriate therapeutic guidelines. The actual incidence rates, natural history, and pathophysiologic factors surrounding these complications are unclear. For prevention, the best tools are the assessment of the risk factors and consequences. The treatment options are immediate recognition of the situation, disease progress, pain control, anticoagulation, specific therapy.