Open Access Case Report

Anesthetic Management in a Twin Pregnant Woman with Multiple Drug Allergies Undergoing Cesarean Section: A Case Report

Seong Shin Kim, Byung Gun Lim, Seok Kyeong Oh, Jae Hak Lee

Journal of Advances in Medicine and Medical Research, Page 26-30
DOI: 10.9734/jammr/2021/v33i1931075

Patients with multiple drug allergies (MDA) can be in danger during anesthesia due to their possibility of anaphylaxis. Perioperative anaphylaxis can occur more frequently in patients with any kind of allergic history. The physiological changes during pregnancy, the existence of the fetus itself, and consequent restrictions on drug use including anesthetics make anesthetic management for pregnant women with MDA more difficult than that for other patients. Appropriate anesthetic strategy based on detailed history taking, allergological evaluations and cooperation between surgeon and anesthesiologist are essential to performing successful anesthesia. To the best of our knowledge, although there have been some cases about anesthetic management in patients with MDA, there is no reported case about surgical anesthesia for Cesarean section in a pregnant woman with MDA. Here, we present a pregnant woman with MDA who showed a positive response to most of anesthetics and analgesics in the intradermal skin test, successfully managed with an anesthetic strategy using volatile induction and maintenance anesthesia (VIMA) for Cesarean section.

Open Access Case Study

Unifocal Langerhans Cell Histiocytosis Presenting as Spontaneous Pneumothorax

Muhammad Khurram, Saima Ambreen, Muhammad A. Shafiq, Muhammad Naveed Shahzad, Faiqa Zikria, Sarah Yousaf Shah, Hassan Mumtaz

Journal of Advances in Medicine and Medical Research, Page 103-110
DOI: 10.9734/jammr/2021/v33i1931084

Langerhans cell is a rare disease affecting the lungs which has a 10 years survival chance having a prognosis of 85%. It is often linked with smoking. We discuss here the correct stepwise approach towards its diagnosis

Presenting a 28-year-old male smoker with a history of shortness of breath for 2 months which worsened progressively. His chest X-ray showed spontaneous pneumothorax with greater severity towards the right side. HRCT revealed multiple innumerable well-defined cystic lesions of variable sizes in bilateral lung fields, more prominent in upper lobes. A negative suction Pleur-evac was advised but the patient refused it and eventually pleurodesis using bleomycin was done to prevent pneumothorax in the future.

Pleurodesis can improve the symptoms of 88 percent of patients without causing any significant complications. Although pleurodesis does not have any effect on patients' survival, it has a positive impact on their lives continuously by enhancing the quality of life.

Open Access Original Research Article

Epidemiological and Clinical Profile of Patients in the Medical Emergency Department at Amissa Bongo Regional Hospital in Franceville (ABRH), Gabon; Retrospective Cross-sectional Study

Thiery Ndong Mba, Cedric Sima Obiang, Hilaire Kenguele Moundounga, Elvis Othogo N’Nang, Bourdettes Meye, Iris Kévin Ivala Zogo Mba, Arnaud Brice Pambo -Pambo, Landry Eric Mombo, Cyrille Bisseye, Joseph Privat Ondo, Louis-Clément Obame Engonga, Patrick Mickala

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/jammr/2021/v33i1931073

Objective: To evaluate the different non-surgical predominant pathologies in the emergency department of the Amissa Bongo regional hospital in Franceville, Haut-Ogooué.

Materials and Methods: Using consultation registers and some medical records, we retrospectively studied the epidemiological and clinical profile of patients who consulted for a medical and non-surgical or gynaeco-obstetrical emergency, from 1 January 2018 to 31 December 2018.

Results: During this period, 19597 patients consulted for a medical emergency at the Amissa Bongo regional hospital in Franceville in Haut-Ogooué (Gabon). This high score indicated that the majority of patients came from the different districts of the commune of Franceville and other departments of the province. Three periods of high attendance were distinguished: the long dry season (37.3%), the short rainy season (28.4%) and the long rainy season (24%), compared to the short dry season (10.3%). Infectious diseases were recurrent with 63.16%, and with 67% of cases, malaria (severe and simple) was more frequent. Non-infectious emergencies were also noted, such as diseases of the respiratory system (1791 cases = 24.81%), diseases of the digestive system (1028 cases = 14.24%), skin diseases (809 cases = 24.81%), cardiovascular diseases (800 cases = 11.21%), blood diseases (686 cases = 9. 5%), diseases of the urogenital system (588 cases = 8.14%), diseases of the locomotor system (510 cases = 7.06%), ENT diseases (451 cases = 6.24%), diseases of the glands and metabolism (296 cases = 4.10%), diseases of the nervous system and the senses (260 cases = 3.60%)                                                     

Conclusion: Compared to non-infectious diseases, infectious and parasitic diseases are recurrent at CHRAB. They therefore require special attention from the health authorities of this hospital, and even of Gabon.

Open Access Original Research Article

Extended Letrozole Versus Recombinant FSH in Ovulation Induction in Cases of Clomiphene Citrate Resistant Polycystic Ovary

Nehad Maher Motit, Ayman Abdelaziz El-Dorf, Shahinaz Hamdy Elshourbagy, Manal Mostafa Abdullah

Journal of Advances in Medicine and Medical Research, Page 31-39
DOI: 10.9734/jammr/2021/v33i1931076

Background: Clomiphene citrate (CC) is still the traditional therapy used for inducing ovulation in polycystic ovary syndrome (PCOS). Clomiphene resistance, which refers to persistence of anovulation after standard CC therapy, occurs in 15%–20% of patients. We aimed to compare between extended letrozole versus recombinant FSH in ovulation induction in cases of clomiphene resistant polycystic ovary

Methods: Seventy women with PCOS were included then patients were equally randomized to receive one of the two drugs to be given over the next 3 months. In current study Group A: letrozole group 2.5 mg two tablets once daily for 10 days from day 2 of menses. Group B: Recombinant FSH 75 i.u s.c daily from day 2 for 5 days then monitoring dose according to folliculometry.

Results: There was non-significant difference between two groups as regard FSH and LH but as regard Serum E2 (pg/mL) at day 5 of HCG administration there was significant higher in FSH recombinant group. There was insignificant difference between two groups as regard Ovulating, Number of follicles >18. There was insignificant difference between two groups as regard Size of dominant follicle, endometrial thickness at hCG (mm). OHSS, discontinuation due to OHSS, clinical pregnancy, multiple pregnancy and abortion was higher in FSH recombinant group but differences didn’t reach significance.

Conclusions: There was non-significant difference between two groups in relation to ovulation, Number of follicles, Size of dominant follicle, Endometrial thickness at day of HCG injection however it was reported that OHSS, discontinuation due to OHSS, positive pregnancy test, was higher in FSH recombinant group but differences didn’t reach significance level.

Open Access Original Research Article

Evaluation of the Normal Range of C-reactive Protein and Erythrocyte Sedimentation Rate Serum Level after Total Knee Arthroplasty and Total Hip Arthroplasty in Osteoarthritis Patients without Complications

Mohammad Amin Aslani, Fateme Mirzaee, Amin Karimi, Amir Farahanchi Baradaran, Zohreh Zafarani, Hamidreza Aslani

Journal of Advances in Medicine and Medical Research, Page 40-46
DOI: 10.9734/jammr/2021/v33i1931077

Aims: Infection is one of the most serious complications of joint replacement surgeries. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) serum levels are widely used for the evaluation of acute infections after joint replacement surgeries. The aim of our study is to determine normal changes in these inflammatory mediators after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methodology: In our study, we enrolled 100 patients with mean age of 68 y/o (57–77) and the diagnosis of primary osteoarthritis who underwent joint replacement surgery. ESR and CRP serum levels were measured before surgery, as well as one, three, and five days after surgery and then again 14, 42, and 90 days after surgery. The results were compared in two groups of TKA and THA, and patients who had undergone THA were further divided into cemented and uncemented groups.

Results: The CRP serum level increased rapidly and reached its maximum level (130.47) on the third day after surgery and returned to its pre-surgery level at the end of three months in all patients. The ESR serum level reached its peak (142.65) on the fifth day after surgery and then decreased; however, it was still slightly higher than the pre-surgery levels at the end of three months. CRP showed faster and more remarkable level changes following surgery compared to ESR, and this elevation was unrelated to the pre-surgery levels. No significant difference was observed between the cemented and uncemented groups.

Conclusion: Changes in CRP and ESR levels after TKA and THA surgeries are reliable indicators for assessment of prosthetic infections. In cases with an elevated CRP serum level on the third day of surgery, a strong suspicion of infection seems completely rational.

Open Access Original Research Article

Chronic Low Back Pain Manifestation among Bank Workers in Southern Nigeria: A Current Disorder Exacerbated by Long Hours on Uncomfortable Chairs

Briggs, Bieye Renner, Hanson Asikiya Huldah

Journal of Advances in Medicine and Medical Research, Page 47-54
DOI: 10.9734/jammr/2021/v33i1931078

Banks play key roles in the economies of the world. The bank industry determines the growth of economies in all countries, as a result, workers in this industry are subjected to conditions geared towards getting the highest degree of performance from them consistently. Most of their time is spent sitting down, using computers, assuming bent postures, doing repetitive work, and sometimes without enough breaks in-between hours can predispose them to occupational hazards. This study aims to determine the prevalence of chronic low back pain among bank workers in Port Harcourt Metropolis through its associated risk factors. The study design was descriptive cross-sectional. The sample (N=332) consisted of 332 employees from twelve banks. A self-administered, closed-ended, structured questionnaire was used to collect data, and a Chi-square test (p=0.05) and odds ratio with a corresponding 95 % confidence interval was obtained. Results:  Showed significant relationship between age and chronic low back pain [OR=2.87; 95 % CI=1.75 – 4.72; p=0.001], length of time in seated position had significant relationship between workers that sat for six hours and above and chronic LBP (OR=1.89; p=0.01; 95 % CI: 1.16-3.06). Also, respondents who do not sit in a comfortable seat at the office were 2.60 times more at odds of experiencing chronic low back pain compared to respondents whose seats are comfortable (OR=2.60; p=0.001; 95% CI: 1.51-4.45). Conclusion: This study shows that the risk factors of a long hour of sitting, uncomfortable chair, bent posture leads to chronic low back pain over time. Therefore, it is recommended that proper break time be observed, right ergonomics to prevent twisting the back. 

Open Access Original Research Article

Maternal Vitamin D Status in Gestational Diabetes Mellitus Women

Zainedeen Nassar, Mazen Alzaharna

Journal of Advances in Medicine and Medical Research, Page 55-63
DOI: 10.9734/jammr/2021/v33i1931079

Aims: To assess vitamin D status among Gestational Diabetes Mellitus pregnant women in Gaza Strip.

Study Design: Case control study.

Place and Duration of Study: Samples were collected from pregnant women attending primary health care centers, Gaza, Gaza Strip.

Methodology: The study comprised 90 participants, 45 GDM pregnant women and 45 apparently healthy pregnant women. Serum vitamin D and insulin levels were measured by ELISA, fasting blood glucose (FBG), 2 h oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), triglycerides (TG), cholesterol, high-density lipoprotein (HDL), phosphorus and calcium were determined chemically. Blood pressure was measured. Body mass index (BMI) and low-density lipoprotein (LDL) were calculated. Ethical approval was acquired from Helsinki committee. All data was analyzed using the SPSS program.

Results: The average vitamin D in GDM cases was lower than that in controls (P=0.031). There was an increase in the average of FBG, OGTT, HbA1c and insulin levels in GDM cases versus controls (P<0.001). The average levels of serum cholesterol, TG and LDL were significantly higher in cases as compared to controls. The average systolic and diastolic blood pressure levels were higher in GDM cases in relation to controls. Pearson correlation test showed a significant negative correlation between vitamin D and the parameters: BMI, glucose, OGTT, HbA1c and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).

Conclusion: Vitamin D was lower in GDM women compared to controls. Low vitamin D status may be associated with insulin resistance and act as a risk factor for GDM.

Open Access Original Research Article

Correlation between Clinical Tests and Magnetic Resonance Imaging Finding in Diagnosis of Chronic Ulnar-sided Wrist Pain

Islam Talaat Khalil Attia, Ali Mahmoud Emran, Elhafez Abd Elgafez Megahed, Mamdouh Fouad Lashin

Journal of Advances in Medicine and Medical Research, Page 64-70
DOI: 10.9734/jammr/2021/v33i1931080

Background: Ulnar-sided wrist pain is a common cause of upper- extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Carful clinical examination should be done, there are some provocative tests for some pathologies which induce pain when the patient has the specific pathology for the test. MRI of the wrist is often challenging because the components of the wrist have complex anatomy of bone and soft tissues, with ligaments and cartilage which are small sized structures measuring millimeters. MRI is a one of advanced imaging techniques that play an important role in evaluating the wrist and is a useful examination modality because of its multiplanar, multisequence capability and its excellent resolution of soft tissue structures. MRI is particularly advantageous for assessing occult bone lesions and soft tissue structures around the wrist such as cartilages, tendons, ligaments and nerves.

Aim: The aim of this study is to assess the role and accuracy of clinical tests and MRI in diagnosis of chronic ulnar-sided wrist pain causes.

Patients and Methods: This is a prospective study and was conducted on a 50 adult patients complaining from chronic ulnar side wrist pain. They were attended to Orthopedic Department of Tanta University Hospitals over a period of 6 months starting from November 2019 till May 2020.

Results: MRI gave positive finding in most of patients (92%), while negative in about (8%) of cases, this means that there are some pathologies need more investigations to be diagnosed. Most of Clinical tests also gave a help in diagnosis of the cause of the pain especially ulnocarpal stress test, fovea sign test, ECU synergy test and piano key test which by statistics showed significant results but LT ballottement test had insignificant results so LTL pathology can't be diagnosed by clinical tests only but needs more investigations as MRI. So some pathologies can be diagnosed clinically as ECU tenosynovitis, but other pathologies need more investigations like MRI like LTL tear, also some pathologies need more investigations.

Conclusion: Most of clinical tests give significant results in diagnosis of chronic ulnar-sided wrist pain except for some pathologies like LTL tear needs more investigations, also MRI has important role and gives significant results in diagnosis.

Open Access Original Research Article

Anti-Mullerian Hormone (AMH) Level in Presence of Ovarian Endometrioma

Nesma F. Radwan, Ahmed M. El Khyat, Adel E. El gergawy, Hesham A. Salem

Journal of Advances in Medicine and Medical Research, Page 71-85
DOI: 10.9734/jammr/2021/v33i1931081

Background: The effect of endometriomas itself on the ovarian responsiveness that relate to ovarian reserve had been reported with several inconsistent results. In one study evaluated women with unilateral endometriomas, ovaries with disease showed lower response to ovarian stimulation than contralateral healthy ovaries .However, recent study on infertile women with un-operated unilateral small endometriomas did not support difference in ovarian responsiveness. The aim was to evaluate the impact of presence of endometriomas on ovarian reserve as measured by circulating AMH.

Methods: This retrospective study was carried out on 80 female patients in childbearing period attending outpatient clinic and/or inpatient department of obstetrics and gynecology at Tanat University Hospital and the study was conducted directly after approval in the period from Apri, 2019 till April 2020.

Group (A): Study group: 60 female patients aged between 20 to 30 years old

GROUP (B): Control group: 20 age matched female with healthy ovaries.

Results: there is no statistical significant difference between groups as regard Menarche (years), Regularity and Amount of menstrual blood flow. There is statistical significant difference between groups as regard fixed tender Right Ventricular Failure. But there are no statistical significant differences between groups as regard nodule in rectovaginal septum, fixed tender adnexal masses, association with adenomyosis and infertility. There is highly statistical significant difference between case and control groups as regard AMH levels. there are highly statistical significant positive correlation between duration of endometriosis and each of presence of pelvic pain, cyst diameter and Visual Analogue Scale.

Conclusions:    Women with endometrioma have significantly lower serum AMH levels and seem to experience a more rapid decline in serum AMH levels than age matched counterparts, suggesting a harmful effect of endometrioma per se on ovarian reserve.

Open Access Original Research Article

Admission Patterns in the Children’s Emergency Room of Enugu State University Teaching Hospital, during the COVID-19 Pandemic

Ndu I. K., Asinobi I. N., Nduagubam O. C.

Journal of Advances in Medicine and Medical Research, Page 86-92
DOI: 10.9734/jammr/2021/v33i1931082

Aims: This study aimed to compare the difference in admission rates and severity of illness in 2019 and during the peak time period of the global SARS-CoV-2 pandemic of 2020 in children presenting at the Children’s emergency room (CHER) of Enugu State University Teaching Hospital, Enugu.

Study Design: This was a cross-sectional study.

Place and Duration of Study: Children’s emergency room (CHER) of Enugu State University Teaching Hospital, Enugu, from June 1 to August 31, 2019 and 2020 were reviewed, respectively.

Methodology: The admission records of all the children that were admitted into CHER of Enugu State University Teaching Hospital (ESUTH), Enugu, over a three-month period from June 1 to August 31, 2019 and 2020 respectively were reviewed.

Results: A total of 310 and 184 patients were seen during the study period for 2019 and 2020, respectively (40.6% decrease). A significant number of patients spent two days on admission in the children’s emergency room in 2020 than in 2019 (P < .001). Emergency admissions were 3 times more in year 2020 than in year 2019 (OR = 2.624, 95% C.I = 1.797 – 3.833, P < .001).

Conclusion: Although this study reported decreased emergency room admissions, there was an increase in the mortality rate and emergency presentations.

Open Access Original Research Article

Does Galectin3 Immunohistochemical Marker Help in Diagnosing the Nature of Benign or Malignant Thyroid Tumor?

Umm-e -Farwa, Rehana Ramzan, Mahwish Niaz, Hassan Salim, Rabiya Fawad, Nadia Tasawer, Kashif Bangash, Hassan Mumtaz, Shahzaib Ahmad

Journal of Advances in Medicine and Medical Research, Page 111-119
DOI: 10.9734/jammr/2021/v33i1931085

Introduction: Galectin-3 has been reported quite accurate to detect or exclude malignancy in nodules with prior indeterminate Fine Needle Aspiration Cytology and per operative findings. Keeping this fact in mind, Galectin-3 can have a pivotal role in separating benign from the malignant thyroid neoplasms.

We aim to determine the frequency and intensity of Galectin-3 immunohistochemical expression among benign and malignant thyroid neoplasms confirmed on histopathology.

Materials and Methods: We studied 78 thyroid specimens diagnosed with thyroid neoplasms on histopathology. Out of these 39 were benign cases (follicular adenoma and hurthle cell adenoma) and 39 were malignant cases (papillary thyroid carcinomas, follicular carcinoma, medullary carcinoma and poorly differentiated carcinoma). Each specimen was examined grossly and microscopically and checked for immunohistochemical staining pattern of Galectin-3 under the microscope.

Results: Age range in this study was from 15 to 65 years with mean age of 44.97 ± 10.78 years. Out of these 78 patients, 17 (21.79%) were male and 61 (78.21%) were female with male to female ratio of 1:3.6. Frequency of positive Galectin-3 immuno histochemical expression among thyroid neoplasms was found in 32 (41.03%) cases with Galectin-3 showing positive staining in 21 (53.85%) of all malignant and 11 (28.21%) of all benign cases .Among the malignant neoplasms, positivity was seen most frequently in papillary thyroid carcinomas as compared to the other malignancies.

Conclusion: This study concluded that positive Galectin-3 immunohistochemical expression is more in malignant thyroid neoplasms (53.85%) as compare to the benign lesions (28.21%). Therefore, we recommend that this marker cannot be used alone for the routine diagnosis of malignant lesions as it has shown less sensitivity and specificity. Moreover it also has shown no significant role in differentiating between the benign and the malignant thyroid neoplasms.

Open Access Original Research Article

Urethral Prolapse in Prepubertal Girls in Port Harcourt, Nigeria: A Multicentre Study

Isesoma Gbobo, Goddy Bassey

Journal of Advances in Medicine and Medical Research, Page 120-125
DOI: 10.9734/jammr/2021/v33i1931086

Background: Urethral mucosa prolapse is a rare condition mainly seen in prepubertal girl with racial predilection for black girls.

Methodology: This was a multicenter 7-year retrospective analysis of 27 cases of urethral mucosa prolapse treated at the university of Port Harcourt teaching hospital and private health facilities in Port Harcourt from 2011-2018. Relevant information extracted from the case files include age, clinical presentation, examination findings, treatment modality and post-operative complications. Data was entered and analyse using SPSS version 25 and results were presented in simple percentages and frequency tables

Results: The institutional prevalence of urethral prolapse was 0.14%. The commonest presenting complaint was blood stains on the underwear in 23 (85.2%) patients while all patients presented with the characteristic ‘doughnut sign’ of a circumscribed fleshy mass surrounding the urethral meatus. All patients had intact hymen. Surgery was the primary treatment modality in 24 (88.9%) cases while conservative medical management was carried out in three (11.1%) patients. The success rate for surgical management was 100% and 33.3% for medical treatment. The commonest post-operative complication was dysuria reported in 7 (25.9%) cases and acute urinary retention was reported in one (3.75) patient.

Conclusion: Urethral mucosa prolapse is a rare but important condition in prepubertal girls presenting with vaginal bleeding due to the suspicion of sexual abuse. Surgical treatment offers better outcome amongst the studied population.

Open Access Original Research Article

Assessment of Myocardial Salvage Index after Primary Percutaneous Intervention of ST Elevation Myocardial Infarction Patients Using Myocardial Magnetic Resonance Imaging Techniques

Asmaa Ramadan Abd El Naby, Magdy Mohamed Elmasry, Mai M. Abd Elmoneim Salama, Mohamed El Sayed El Setiha, Raghda Ghonimy Elsheikh

Journal of Advances in Medicine and Medical Research, Page 126-138
DOI: 10.9734/jammr/2021/v33i1931087

Objectives: The aim of this work was assessment of myocardial salvage using various magnetic resonance imaging techniques immediately after primary percutaneous coronary intervention of ST elevation myocardial infarction patients and at midterm follow up.

Methods: The current study was conducted on 30 patients referred to Aswan heart center or Cardiology department, Tanta University hospital with a diagnosis of ST elevation myocardial infarction during the period from august2017 to December 2017. All patients were subjected to history taking ,clinical assessment ,12 lead ECG, Laboratory biomarkers including cardiac enzyme biomarkers, complete blood count, liver function test, renal function test and lipid profile primary then primary percutaneous coronary intervention was done then cardiac magnetic resonance imaging within 3 days and after 3 months including the following sequences: Steady-state free precession, T2 weighted triple inversion recovery sequence and Early and late gadolinium enhancement to measure the area at risk and myocardial salvage index.

Results: Myocardial salvage index was found to improve with improving thrombolysis in myocardial infarction (TIMI) flow post intervention (p value=0.004), also the presence of microvascular obstruction (p value =0.034) and intramyocardial hemorrhage (p value=0.014) had a negative impact on myocardial salvage index. Peak cardiac enzyme biomarkers (troponin p value=0.001,CK p value=0.005,CKMB p value=0.002) were also associated with increased area at risk however did not affect the myocardial salvage index.

Conclusion: Proper management of the occluded coronary artery is a corner stone in improving myocardial salvage index which can be properly assessed with cardiac MRI.

Open Access Original Research Article

Functional Brain Alterations in Individuals with Motor Conversion Disorder

Mai Ahmed Salem, Mohammad Abdel Hakeem, Rasha Ahmed El Shafey, Gamal Ibrahim Taha shamma, Ahmed Abdel Rahman Mubarak

Journal of Advances in Medicine and Medical Research, Page 139-150
DOI: 10.9734/jammr/2021/v33i1931088

Background: Conversion disorder (CD) is characterized by neurological symptoms affecting voluntary motor control and incompatible with organic damage to the nervous system. Since novel insights have been gained with the advent of functional magnetic resonance imaging, we aimed to explore potential functional alterations in various areas of the brain in a sample of Egyptian patients suffering from conversion disorder.

Methods: This cross-sectional study was carried out on patients who met the DSM-5 criteria for conversion disorder presented with weakness or paralysis aged from 18- 40 years old. Group A (Cases): include 30 patients with motor conversion disorder. Group B (Control): include 30 normal healthy individuals free from any psychiatric disorders. Structured Clinical Interview DSM-IV (SCID-I) and (SCID-II) were applied for psychometric evaluation.

Results: The cases had increased activity in the contralateral amygdala of the affected side of patients with CD. Cases also showed decreased activation of contralateral basal ganglia in the affected side as well as a decreased activity of the motor cortex contralateral to the affected side. There was a decrease in activation of SMA contralateral to the side of disability. There was an increase in the activity of the contralateral insula.

Conclusions: Functional abnormal alterations in motor and sensory systems are related to the presence of neurological symptoms in conversion disorder.

Open Access Original Research Article

Effectiveness of Laparoscopy and Hysteroscopy to Optimize the Outcome of Assisted Reproductive Technology

Mostafa Hussein Emam, Shereef Lotfy Elshwaikh, Diaa Mounir Aglan, Mostafa Zain Elabedin Mohamed

Journal of Advances in Medicine and Medical Research, Page 93-102
DOI: 10.9734/jammr/2021/v33i1931089

Background: Identifying the cause of infertility is complex and often reveals overlapping etiologies. Because of the valuable characteristics of hysteroscopy, it has been deemed a promising surgical intervention to improve in vitro fertilization (IVF) outcomes. The present study aimed to evaluate the role and effectiveness of combined laparoscopy and hysteroscopy in the assessment of uterine pathologies in infertile women with recurrent implantation failure (RIF) after IVF, and explore whether removal of such pathologies increased the rate of pregnancy in those women.

Methods: This prospective observational cohort study included 40 infertile patients presented with either primary or secondary infertility after repeated IVF/ intracytoplasmic sperm injection (ICSI) failure. Participants were selected from Endoscopy and Assisted Reproductive units in Obstetrics and Gynecology department at Tanta University Hospital.

Results: There was a statistically significant higher rate of successful cases in the abnormal hysteroscopic findings group. There was no statistically significant difference between normal and abnormal laparoscopic findings groups as regard successful ICSI procedure.

Conclusions: Hysteroscopy is recommended to be a routine diagnostic and therapeutic tool in any case with RIF or recurrent IVF/ICSI failures before a new attempt as it increases the success rate. We can’t recommend routine laparoscopy in any case with RIF or recurrent IVF/ICSI failures.

Open Access Original Research Article

Nifedipine or Labetalol: Hypertension Management during Pregnancy

Zoobia Z Khan, Ahmed Sohail, Atif Yusufzai, Hassan Imtiaz, Neelam Asghar, Hassan Mumtaz, Shahzaib Ahmad, Syed Abdul Ahad, Mohammad Hasan

Journal of Advances in Medicine and Medical Research, Page 151-156
DOI: 10.9734/jammr/2021/v33i1931090

Introduction: Hypertension complicates 10% of pregnancies causing significant morbidity and mortality worldwide. It is considered severe hypertension if Systolic >160 and Diastolic >110 lasting more than 15 minutes. It is an Obstetric emergency and needs prompt appropriate treatment.

Methods: A quasi-experimental study was conducted at Tehsil Headquarter Hospital. One hundred fifty patients were included in the study divided into two groups: Nifedipine group (n:75) getting oral Nifedipine and Labetalol group (n:75) getting IV Labetalol.

Results: This study shows that goal therapeutic blood pressure was reached earlier in patients receiving oral Nifedipine 28.2 ± 11.7minutes as compared with those receiving intravenous Labetalol 48.4 +- 23.5minutes.

Fewer doses were required for the nifedipine group in contrast to the IV labetalol group Failure of treatment was higher among the IV labetalol group.

Conclusion: Oral nifedipine is as productive and safe as compared to Iv labetalol and is more convenient in Low resource settings.

Open Access Original Research Article

Evaluation of Serum Level of Vitamin D in Patients with Female Pattern Hair Loss Thesis

Manar Elsayed Taha Sadoma, Ghada Fawzy Rezk Hassan, Manal Mohamed ALI Elbatsh, Zeinab AbdElsamd Ibrahim

Journal of Advances in Medicine and Medical Research, Page 157-162
DOI: 10.9734/jammr/2021/v33i1931091

Background: Female pattern hair loss (FPHL) is the most common cause of alopecia in women, characterized by diffuse non-scarring hair loss in frontal, central, and parietal areas of the scalp. Vitamin D is a factor that has recently been considered in dealing with these patients. 

Objective: The aim of this work was to evaluate the serum level of 25 hydroxy vitamin D in patients with FPHL to elucidate its possible role in the pathogenesis of the disease.

Methods: This study included 45 patients with female pattern hair loss; Evaluation of vitamin D level by Elisa was done for both control and patients.

Results: Regarding vitamin D levels, mean ± SD. 18.0 ± 11.97.

Conclusion: This study indicated the correlation between FPHL and decreased serum levels of Vitamin D3. It is recommended to evaluate serum Vitamin D3 levels as well as other hormone assays in these patients.

Open Access Original Research Article

What about the Antibacterial Activity of Fresh Ginger Juice (Zingiber officinale)?

E. Günaydın, Gülşen Goncagül, Çiğdem Güceyü, Ö. Kardoğan

Journal of Advances in Medicine and Medical Research, Page 163-172
DOI: 10.9734/jammr/2021/v33i1931092

Background: The aim of this study was to determine the antibacterial activity of the juice obtained by squeezing fresh ginger roots (Zingiber officinale) against the standard strains Staphylococcus aureus (ATCC® 25923) and Escherichia coli (ATCC® 25922), as well as Acinetobacter baumannii and Klebsiella pneumoniae isolated from patients hospitalized in intensive care units.

Methods: For this purpose, the antibacterial effect of the fresh ginger juice was tested against antibiotics such as ampicillin, cefazolin, cefuroxime, meropenem, colistin, ofloxacin, sulfamethoxazole/trimethoprim, tetracycline, and gentamicin. The antibacterial effects against the tested bacteria were determined by the disc diffusion method using 5 µL, 10 µL, 15 µL and 20 µL amounts of ginger juice impregnated on sterile discs.

Results: As a result of the study, it was detected that the antibacterial effect increased in parallel with the increasing amounts of fresh ginger juice in all tested bacteria.

Conclusion: Consequently, fresh Zingiber officinale can provide protection to a certain extent against bacterial pathogens due to its antibacterial action.

Open Access Original Research Article

Knowledge, Attitude and Practices of Mothers towards Fever and Its Home Management among Under Five Children in Kom Hamada City, Behira Governorate, Egypt

Manal Mohamed Alnaser Hassona, Salwa Abd El-Mageed Atlam, Safinaz El-Said Shalaby

Journal of Advances in Medicine and Medical Research, Page 173-185
DOI: 10.9734/jammr/2021/v33i1931093

Background: Fever is one of the most common presenting complaint in pediatric age and is the cause of nearly 70% of all pediatric clinic visits. Fever isn’t a disease but a symptom of disease, so we need to do more to communicate the message to parents.

Aim: To assess knowledge, attitude and practices of mothers towards fever and its management at home among under five children and to find-out some factors influencing maternal knowledge, attitude and practices.

Subjects and Methods: A cross sectional study was carried out in Maternity and Child Health Care Center in Kom Hamada city, Behira Governorate. A sample of 384 mothers was included in the study. The study was done via a pre-designed questionnaire sheet filled through direct interview with target mothers to assess their knowledge, attitude and practice regarding fever management of their under five children.

Results: Most of the studied mothers had good knowledge (62%) and positive attitude (59.9%). But (39.3% and 38.8%) of them had bad and fair practice respectively. Bad practice was common in the age group 25-30, those having three or four children, urban residence and with decreased family income.

Conclusion: The results found that awareness was relatively good. The study highlights the numerous misconceptions regarding fever management. So health education of mothers is needed to improve mother’s practice.

Open Access Original Research Article

The Value of Serum Adiponectin in Patients with Polycystic Ovary Syndrome

Hagar Abd Elrahman Deghaidy, Mona Khalid Omar Amira Youssef Ahmed, Elsayed Fetouh Rakha

Journal of Advances in Medicine and Medical Research, Page 186-197
DOI: 10.9734/jammr/2021/v33i1931094

Background: Polycystic ovary syndrome (PCOS) is a common condition in women at reproductive age associated with reproductive and metabolic dysfunction. It may be the most common cause of anovulation, early pregnancy loss, and later pregnancy complications. Adiponectin is the most abundant adipokine and is mainly secreted from visceral fat cells. It might be responsible for the metabolic and neuroendocrine derangements characteristic of obesity and obesity-related disease, such as PCOS. We aimed to evaluate the level of serum adiponectin in PCOS and the potential use of adiponectin as a biomarker for PCOS.

Methods: This case control study was carried on 100 patients, aged between 20–35 years, who were equally divided into four groups based on the diagnosis of PCOS; 2 case groups and 2 control groups. Group 1 were non-obese PCOS subjects with body mass index (BMI) <25 kg/m2. Group 2 were obese PCOS subjects with BMI >25 kg/m2. Control groups were selected as; group 3 were non-obese control group with BMI <25 kg/m2. Group 4 were obese control group with BMI >25 kg/m2.

Results: Adiponectin was significantly lower in group 1 than group 3 and 4 (P2 and P3 <0.001). While it was significantly lower in group 2 than group 1, 3 and 4 and was significantly lower in group 4 than group 3 (P1 = 0.021, P4 and P5 <0.001).

Conclusion: Serum adiponectin level may be taken into consideration as a biomarker for confirmation of PCOS diagnosis. The relationship between adiponectin and BMI suggests that adiponectin could serve as a marker for disease risk and provide opportunity for earlier intervention.

Open Access Original Research Article

Morphometric Evaluation of Frontal and Maxillary Sinuses and Bizygomatic Distance of Igbos In South-East and Ogonis in South-South Nigeria Using Computerized Tomography Scan

Godson Emeka Anyanwu, Salome Nwaelom Ezeofor, Emmanuel Nebuwa Obikili, Ekene Valentine Ugbor

Journal of Advances in Medicine and Medical Research, Page 198-208
DOI: 10.9734/jammr/2021/v33i1931095

Background: Radiological identification is important in clinical, surgical and forensic medicine particularly in the absence of comparative deoxyribonucleic Acid (DNA) samples and fingerprints. Aim is to establish the morphometry of frontal sinus (FS), maxillary sinus (MS) and bizygomatic distance (BZD) and their relationship with age and gender in Igbos and Ogonis of Nigeria using computed tomography (CT).

Methods: Head CT scans of 625 subjects (477 Igbos and 148 Ogonis) between 18 and 85 years, showing normal FS, MS and BZD, were measured using DICOM viewer software. The Igbos and Ogonis were 247 males and 230 females; 84 males and 64 females respectively. The height, width and depth of the sinuses, intermaxillary sinus distances (IMD) and BZD were measured in centimeters (cm). The data were analyzed using SPSS version 20 and difference between groups was obtained using one way ANOVA. P-value less than 0.05 was considered as statistically significant.

Results: Mean values for the right and left MS volume for the Igbos are 13.79 ±10.91 and 13.81±11.03 and for the Ogonis 20.84±5.83 and 20.19±5.59 cm respectively. All FS dimensions are higher in the Igbos (P<0.001) except right FS depth. Mean IMD are 3.64±0.50 and 3.39±0.45 cm in the Igbos and Ogonis respectively (P<0.001). Ogonis have higher BZD (P>0.05). In both groups, males had larger values in both FS depth, MS dimensions and BZD (P<0.001). Age correlated positively with left FS height and IMD. Prevalence of unilateral FS aplasia was 3.35% on the right and 1.47% on the left among the Igbos while the Ogonis have 2.03% on the right and 2.70% on the left. Bilateral FS aplasia was 2.94% among the Igbos but not observed among the Ogonis.

Conclusion: Normative values is established. Ethnic differences exists with Igbos significantly having higher values of FS and IMD while in the Ogonis, the MS dimensions are higher. These findings would act as a guide for facial reconstructive surgeries, forensic experts and classification of fossil remains in anthropology.

Open Access Original Research Article

An Analysis between Patient Demographics and Non-attendances in General Surgery Clinics at an NHS Trust: An Audit

A. W. Y. Ng, G. H. C. Lim, A. Winarski, E. Ross, E. J. Nevins, A. Gilliam

Journal of Advances in Medicine and Medical Research, Page 209-214
DOI: 10.9734/jammr/2021/v33i1931096

Background: Missed clinic appointments can have bearing on a multitude of factors including patient care, hospital management and resources.

Aim: To assess the non-attendance rates to surgical clinics within our trust. Secondary outcomes will be to assess the correlation between travel distances to clinic, time of year, patient demographics, and whether the appointment is a new patient or follow-up, on DNA rate. 

Methods: Retrospective audit including all patients attending outpatient general surgical appointments at all 5 district general hospitals within the trust between the fiscal years of April 2016 to March 2018. Using case notes and electronic patient records, data on patient demographics, type of appointment, time of year and distance from hospital were collected. 

Results and Conclusions: There is correlation between DNAs and age, gender, ethnicity, subspecialty, and distance from hospital. The reasons behind DNAs will be multifactorial and efforts should be made to investigate the barriers to attendance.

Open Access Original Research Article

Solcoseryl versus Low Molecular Weighte Heparin for Intrauterine Fetal Growth Restriction

Samar M. Abd El-Razek, Mohammed M. Elnamory, Mona K. Omar, Hesham M. Eltokhy

Journal of Advances in Medicine and Medical Research, Page 215-228
DOI: 10.9734/jammr/2021/v33i1931097

Background: FETAL Growth Restriction (FGR) is a problem where the fetus fails to attain its normal growth potential and this affects nearly about 8% of all pregnancies Solcoseryl is a protein-free and antigen-free haemodialysate derived from calf blood. It is thought to activate the cellular respiratory chain leading to better oxygen utilisation by the tissues. Aim of the study was to compare between Solcoseryl and low molecular weight heparin in treatment of patients suffered from intrauterine growth restriction due to placental insufficiency.

Methods: The patients who included in this study were divided randomly via (computer-generated random numeric tables prepared by a statistician) into two groups with 35 cases in each group. Group (A) (Solcoseryl. Group): 35 women received Solcoseryl ampule 42.5 mg intravenous infusion (Misr Compony) Once daily for 3 weeks. Group (B) (LMWH (Clexan) Group): 35 women received single dose of LMWH subcutaneous (clexane 40 mg) once daily for 3 weeks.

Results: There is a significant decrease regarding umbilical artery RI in both groups but the significant decrease was better in group A compared to group B. Otherwise, there is no significant difference between the two groups umbilical artery RI at different time intervals. there is significant increase in Gestational age and birth weight in patients who receive solcoseryl and LMWH .There is an improvement in Doppler indices of both (UA and MCA) in  both group but is better in solcoseryl than LMWH and significant increase  in Apgar score at 1min and 5 min in both groups but is better in solcoseryl than LMWH.

Conclusions: In this study, LMWH and Solcoseryl administration in IUGR fetuses enhance Doppler indices, promote significant increase in Gestational age so enhance neonatal birth weight.

Open Access Original Research Article

Physical Pain and Psychosocial Predictors of Sexual Activity among Multicultural Older Women

Luciana Lagana, Shayna Greenberg, Ovsanna Balian

Journal of Advances in Medicine and Medical Research, Page 229-243
DOI: 10.9734/jammr/2021/v33i1931098

Aims: To investigate the relationships between facets of sexual activity among ethnically diverse older women and indicators of their physical pain as well as their psychosocial wellbeing. Physical pain intensity, intimate relationships quality, non-medical psychological distress, and depressive symptomatology were examined as predictors of yearly frequency of interactional sexual activity with an intimate partner and of masturbation.

Study Design: Cross-sectional.

Place and Duration of Study: Department of Psychology, California State University, Northridge, between September 2017 and December 2018.

Methodology: Thirty-four older women between 50 and 84 years (M = 65.85, SD = 7.75) were recruited. Participants were reasonably fluent in English, lived independently in the community, self-identified as heterosexual, and reported being in an intimate relationship at the time of data collection. A battery of self-report measures was administered by research assistants over two sessions, on average.

Results: Demographics, yearly frequency of interactional sexual activity and of masturbation, physical pain intensity, dyadic adjustment, non-medical distress, and depressive symptomatology were assessed and analyzed. An intercorrelational matrix was produced and two simultaneous multiple regressions were conducted. They revealed that dyadic adjustment was a significant and positive predictor of the yearly frequency of interactional sexual activity, holding all other predictors constant (b = 1.06, P = .02). Dyadic adjustment was not a significant predictor of yearly masturbation frequency (P = .55). Physical pain and psychological predictors were not related to yearly interactional sexual activity or masturbation frequency (Ps > .05).

Conclusion: Greater dyadic adjustment and associated feelings of satisfaction with an intimate relationship predict significantly higher yearly frequency of interactional sexual activity among older women. Additional research is necessary to corroborate the present findings and identify predictors of masturbation.

Open Access Original Research Article

Prospective Study: Optic Nerve Sheath ‎Diameter in Prediction of Fluid ‎Responsiveness in Sepsis Patients

Hadeel Ibraheim Elsagheir, Abd Elaziz Hamed El badawy, Reda Sobhi Salama Abd Alrahman, Mohamed Samir Abd El Ghafar

Journal of Advances in Medicine and Medical Research, Page 244-253
DOI: 10.9734/jammr/2021/v33i1931083

Background: Sepsis is a life-threatening disease caused by the body's reaction to infection, which results in tissue destruction, organ failure, and death. Sepsis affects at least 30 million people worldwide each year, with 6 million people dying as a result. The goal of the research was to see whether the measurement of the Optic Nerve Sheath Diameter (ONSD) could be used to predict fluid responsiveness in hemodynamically unstable individuals.‎

Patients and Methods: This prospective observational (cohort) study was conducted at Tanta ‎University Hospitals in the Surgical Intensive Care Unit for 6 months at least ‎after approval from institutional ethics committee‎.

Results: Demographic data (sex, illiteracy, height, BMI) in our patients of the study there ‎were 34 (81%) male, 8 (19%) female, the age was average from 50.33 (±8.63 ‎SD) with range (25-65), 9 (21.4%) illiterate, 10 (23.8%) primary, 18 (42.9%) ‎secondary, 5 (11.9%) university, the mean value of weight 80.29 (±9.45 SD) ‎with range (60.7-98.8), the mean value of height 170.57 (±7.24 SD) with ‎range (157-182), the mean value of BMI 27.54 (±2.19 SD) with range (24.3-‎‎32).‎

Conclusion: In patients with sepsis, ocular ultrasonography appears to be a non-invasive and simple-to-learn technique for assessing overall fluid status. It may be particularly effective in finding those septic individuals who should avoid further fluid intake since it could cause pulmonary edema or other fluid-related problems.

Open Access Review Article

Assessment of Serum Interleukin-19 Level in Patients with Diabetic Nephropathy

Mariam A. Atiia, Yasser M. Hafez, Maaly M. Mabrouk, Medhat A. Ghazy

Journal of Advances in Medicine and Medical Research, Page 15-25
DOI: 10.9734/jammr/2021/v33i1931074

Background: Interleukin-19 (IL-19) is a newly discovered cytokine belonging to the Interleukin-10 (IL-10) family. IL-19 has indispensable functions in many inflammatory processes and also can induce the angiogenic potential of endothelial cells. The purpose of present study was to assess the level of serum interleukin-19 (IL-19) in patients with diabetic nephropathy (DN).

Our Study Aimed to assess the level of serum IL-19 in patients with diabetic nephropathy.

Methods: In this cross-sectional study, we tested 90 subjects; 30 healthy control and 60 diabetic nephropathy patients recruited from outpatient clinics and wards of Internal Medicine department, Tanta university hospitals, Egypt. Patients were subdivided into 3subgroup according to the urinary albumin creatinine ratio (ACR).

Results: The serum IL-19 levels in DN patients were significantly higher than the control group. The mean serum IL-19 level was 15.45±4.34 Pg/ml, 32.66±8.05 Pg/ml, 56.03±7.89 Pg/ml and 71.41±12.37 Pg/ml dL for control, normoalbuminuria group, microalbuminuria group and macroalbuminuria group respectively.

Conclusions: Serum IL-19 level was significantly elevated in patients with diabetic nephropathy and was associated with the marker of inflammation CRP (C -reactive protein). So