Open Access Case Report

Late Presentation of Neglected Autoimmune Polyglandular Syndrome

Rania Alsayed Murad, Ashraf Alakkad, Anwar Adwan, Mikdam Al Ramahi

Journal of Advances in Medicine and Medical Research, Page 176-182
DOI: 10.9734/jammr/2021/v33i2031120

A 60-year-old male patient, weighing 40 kg, having a BMI of 13, who was also a known case of Diabetes Mellitus Type II was shifted to the Orthopaedic Ward last month due to a fall, which led him to develop an intertrochanteric fracture in the femur. While the treatment of the patient was in an ongoing status for his fracture, his Diabetes was seen to be poorly controlled, with his blood glucose levels being constantly evaluated to be in a state of severe hypoglycaemia to slightly increased levels of blood glucose. On examination, the patient showed clear signs of being malnourished. He was in a bad and dishevelled state, he had creases on the palmar aspects of his hands and hyperpigmentation on his buccal mucosa. Furthermore, his lab reports revealed abnormalities in nearly every lab test ordered. Not only did he have elevated ACTH levels, but there was also a failure of Cortisol stimulation. His DEXA Scan showed that he was predisposed to develop severe osteoporosis and his malnourished condition was supportive of promoting that condition even more. The patient was diagnosed to be suffering from Autoimmune Polyglandular Syndrome, Type II. This is a rare condition of one of its kind where there is a pre-existence of autoimmune adrenal insufficiency along with either autoimmune thyroid disease or autoimmune diabetes mellitus. Since this condition is rare, it tends to often get overlooked upon diagnosis, leading to misdiagnosis because almost all of the presenting features or the symptoms of the prevalent endocrinological disorders present in this condition mimic either hypothyroidism, or diabetes, or adrenal insufficiency alone, and thus lead to further consequences when the condition does not resolve despite persistent treatment, such as the case in this patient. This paper reviews the background of the patient and the causes that possibly could have made him reach this advanced stage of the disease. The paper also reflects upon the disease, Autoimmune Polyglandular Syndrome Type II, as a whole and elaborates on the symptoms and signs which the patient tens to confuse with other endocrinological diseases. Lastly, this paper shall also review the appropriate management plan for the patient to ease his symptoms and accelerate his recovery process.

Open Access Systematic Review Article

Benefits of Exercise in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Reagan F. Cabahug, Gina L. Montalan, Irma P. Yape, Maria Christina M. Laurenciana

Journal of Advances in Medicine and Medical Research, Page 183-198
DOI: 10.9734/jammr/2021/v33i2031121

Objective: To update Sagar et.al. systematic review and meta-analysis on exercise-based rehabilitation for heart failure.

Methods: A systematic review and meta-analysis of randomized clinical trials on exercised-based cardiac rehabilitation. MEDLINE, OVID and cross references were searched for RCTs published between February 2013 up to August 2018. Trials with at least 6 months follow up were included if exercise training program alone or as a component of comprehensive cardiac rehabilitation was compared with groups without exercise prescription.

Results: A total of 11,989 patients were included in the 43 randomized clinical trials predominantly with reduced EF and NYHA class ll -lll. Exercise training program prescription in heart failure patients reduced the all-cause mortality (RR=0.76; 95%CI= 0.66, 0.87; P= 0.001), all cause hospitalization after 12 months (RR=0.70; 95% CI= 0.52, 0.96; P= 0.02) rehospitalization due to heart failure (RR= 0.49; 95% CI= 0.44, 0.55; P= <0.0001) and improvement in quality-of-life scores (RR= -0.36; 95% CI= -0.58, -0.14; P= 0.002). Among these health quality related outcomes, the all-cause mortality and the hospitalization admission after 12 months follow up showed a significant association with exercise therapy program, particularly on exercise setting(p=0.026) and exercise dose (p=0.013), respectively, as revealed by the univariate meta-regression results.

Conclusion: This study has shown that exercise therapy either in center or home based has benefited heart failure patients in reducing the risk of all-cause mortality up to 12 months, hospital admission up 12 months, and has given a better quality of life. The new studies included have further strengthened the findings of previous studies that an exercise therapy program provides benefit to heart failure patients, either as an “alone” intervention or together with a cardiac rehabilitation program; and that the setting and dose of an exercise therapy program provide significant contribution to a reduced risk in all-cause mortality and hospitalization after 12 months follow up, respectively.

Open Access Systematic Review Article

The Impact of COVID-19 on Eating Disorder Risks and Symptoms in the General Population: A Systematic Review

Alexsandra Urhi, Oluwafemi Akinbode, Hafiz Olatunde, Iyanu V. Olateju, Feyikemi Fasina, Dolly Ogwu, Consolata Uzzi, Bolaji Yoade, Gibson O. Anugwom, Mary Olowere, Matthew O. Owolabi, Adeolu F. Oladunjoye

Journal of Advances in Medicine and Medical Research, Page 229-241
DOI: 10.9734/jammr/2021/v33i2031125

Aims: This study aims to identify the risk factors of eating disorders, evaluate the impact of the pandemic on those with or without pre-existing eating disorders and compare the impact of COVID-19 on the various eating disorders.

Methodology: We searched Public/Publisher MEDLINE (PubMed) and Excerpta Medica dataBASE (EMBASE) databases from January 2019 to May 2021, 11 observational studies were selected out of 81 initially identified articles. The sample size ranged from 15 to 22,374 participants, with a total of 31,404 participants.

Results: Individuals, especially females aged 18-25 years and 30-45 years were shown to be more susceptible to eating disorder risks and symptoms.  Depression and anxiety were shown to be the most prevalent risk factors among all subjects. Exacerbation of symptoms was observed in subjects with the eating disorders except for the anorexia nervosa subgroup which showed minimal changes.

Conclusion: This study established the fact that COVID-19 pandemic had a negative impact on the eating habits of people with or without pre-existing eating disorders (ED). This study also highlights the need for efforts to specifically identify evidence-based measures to support patients with ED during and after a pandemic.

Open Access Case Study

Dentigerous Cyst Associated with a Misaligned Maxillary First Premolar: A Case Report

Hassan Dib, Sarah Farhat, Antoine Berberi

Journal of Advances in Medicine and Medical Research, Page 170-175
DOI: 10.9734/jammr/2021/v33i2031119

Aims: The main goal of the following case report was to shed the light on the importance of thorough clinical, radiological and histological examinations in order to elaborate a final diagnosis of asymptomatic dentigerous cysts detected in unusual locations.

Presentation of Case: A case of dentigerous cyst was identified accidentally in the maxillary left premolar region of an asymptomatic 14-year-old female post an orthodontic consultation. Histological examination of the tissue specimens following enucleation confirmed the diagnosis of a dentigerous cyst.

Discussion: Dentigerous cysts are the second most common odontogenic cysts after radicular cysts. They involve impacted, un-erupted, permanent, supernumerary, odontomas and rarely deciduous teeth. Dentigerous cysts are usually painless but may cause facial swelling and delayed tooth eruption. Extensive maxillary involvement and childhood presentation are rare. Radio-graphic and histological examinations should be done to confirm the diagnosis of a dentigerous cyst.

Conclusion: In our case, we showed the presence of a maxillary premolar dentigerous cyst that was removed by enucleation. The presence of dentigerous cyst is not always associated with a syndrome and its removal is very important to avoid future complications.

Open Access Minireview Article

Recent Advances in Drugs and Vaccines for COVID-19

Meiqin Tang, Xinhuang Yao, Faqing Tian, Man Jiang, Jianshe Yang

Journal of Advances in Medicine and Medical Research, Page 70-81
DOI: 10.9734/jammr/2021/v33i2031106

Several potential COVID-19 therapeutic approaches and SARS-CoV-2 vaccines have been investigated, and final clinical reports are gradually becoming available. In this mini-review, we discussed the history of selected potential therapeutic drugs and newly designed vaccines, as well as other approaches for the COVID-19 treatment, and made a primary evaluation of their clinical effects. Finally, according to the nature of coronavirus we posed a promising design to against the SARS-CoV-2 by the chemi-physical methods through carbon nano-materials modification.

Open Access Original Research Article

Insulin-Like Growth Factor Binding Protein-2 in Systemic Lupus Erythematosus Patients as a Marker of Lupus Nephritis Disease

Zeinab N. ELRefeai ELgody, Ghadah Mahmoud Alghzaly, Mohammed Attia Saad Attia, Mohammed Mohammed Albedawey

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/jammr/2021/v33i2031099

Background: One of the members of Insulin-like Growth Factor Binding Protein family is IGFBP-2 that binds to the Insulin-like Growth Factor (IGF) receptors to regulate IGF biological activities. In nephrotic syndrome IGFBP-2 has also been reported to be increased in children and IGFBP-2 considers as predictor for longitudinal deterioration of kidney function in Type 2 Diabetes. The aim of the work was to assess insulin like growth factor binding protein-2 as a marker for activity of lupus nephritis.

Methods: A cross-sectional study was carried out on 80 subjects and was divided on: Group1: 60 patients with Systemic lupus erythematosus which were subdivided into: (a) 40 Systemic lupus patients with nephritis. (b) 20 Systemic lupus patients without nephritis. Group 2: 20 healthy persons as control (Healthy controls).

Results: there were statistically significant difference in ILGRFBPs2 P1, P2 while P3 was insignificant, Regarding the Systemic Lupus Erythematosus Disease Activity Index (SLEDI) score, there was significant difference between group IA and IB while statistically significant positive correlation between ILGFBPs2 and renal SLEDI score. Regarding ILGFBPs2, Anti-ds DNA Ab titer, renal biopsy classes and activity index, there was a statistically significant positive correlation. Regarding chronicity index and renal SLEDI score, there was insignificant correlation.

Conclusion: Serum IGFBP‐2 is a promising biomarker for lupus nephritis, reflecting disease activity and chronicity changes in renal pathology.

Open Access Original Research Article

Multidetector Computed Tomography in Diagnosis of Mesenteric Vascular ‎Occlusion

Amira Mohammed Salah Abou Dalal, Rania Sobhy Abou Khadrah, Aymen Abdul Hameid Elnemr, Mohammed Fathy Dawoud

Journal of Advances in Medicine and Medical Research, Page 14-26
DOI: 10.9734/jammr/2021/v33i2031100

Background: Multidetector computed tomography (MDCT) has high sensitivity and ‎specificity for diagnosing acute primary mesenteric ischemia (MI). MDCT findings vary ‎widely depending on the cause and underlying pathophysiology. MDCT findings of ‎mesenteric ischemia should be characterized on the basis of the cause‏ ‏that lead to early ‎diagnosis and intervention.

Aim: The aim of the study was to assess the impact of different MDCT phases in ‎diagnosis of mesenteric vascular occlusion (MVO).‎

Patients and Methods: This study that was carried out on 20 patients with suspected mesenteric vascular ‎occlusion who were referred to Tanta University Hospitals and General Surgery ‎Department during a period one year starting from May 2018 till May 2019.‎

Results: Out of the 20 studied patients, 11 (55%) of them was male and 9 (45‎‎%) was female, the age of the studied patients ranged from 40 to 73 years old ‎with mean age 57.10 ± 8.85 years. In our study the predisposing factors for MVO were as follow 6 (30%) had ‎Primary thrombosis, 9 (45%) had cirrhosis, 8 (40%) had Portal hypertension, ‎‎4 (20%) had DM, 4 (20%) had Atherosclerosis, and 2 (10%) had ischemic heart ‎disease.‎

Conclusion: Acute and chronic mesenteric ischemia are morbid conditions that are challenging to ‎diagnose. Patients present with variable, nonspecific signs and symptoms, and the ‎physical examination is often benign. A high index of clinical and radiologic suspicion ‎is thus required for diagnosis  MDCT is an accurate, fast, and non-invasive ‎technique which should be used in clinically suspected patients with MVO in order to ‎confirm the diagnosis identify the aetiology and in addition assessing the bowel loop ‎status for adequate management with good prognosis.‎ Familiarity with the MDCT imaging manifestations of mesenteric ischemia allows ‎for a more precise, prompt diagnosis, early institution of therapy and potentially ‎improved patient outcomes.‎

Open Access Original Research Article

Knowledge, Attitude, and Perception of COVID-19 Pandemic in Enugu, Southeast Nigeria- The Initial Experience

E. K. Mgbe, C. G. Mgbe, S. N. Ezeofor, J. F. Etiki

Journal of Advances in Medicine and Medical Research, Page 27-37
DOI: 10.9734/jammr/2021/v33i2031101

Background: The world is experiencing a global corona virus (COVID-19) pandemic. As of 9th June 2020, over 7 million confirmed cases of coronavirus disease (COVID-19) and more than 400,000 deaths had been reported in more than 30 countries of the world according to World Health Organization.

Aim: We aimed to assess the knowledge, attitudes, and vulnerability perception of Enugu state residents during the coronavirus outbreak in order to facilitate better health care outcomes.

Methodology: A prospective Web-based cross-sectional survey was designed for this study which was conducted in March 2020 among Enugu state residents. The obtained data were coded, validated, and analyzed using Statistical Package for the Social Sciences SPSS software, version 24. Descriptive analysis was applied to calculate the frequencies and proportions and Chi-Square Test was also used. A preliminary phase was conducted to assess the validity and reliability of the questionnaire before its use. 

Results: The study showed that significant number (99.6%) of the respondents had heard about Covid-19 and the most stated source of knowledge was social media (57.6%), followed by Newspaper and television shows (50.2%) while the least was from General Practitioner (GP) (8.9%). There was over 75% agreement with, and practice, of all known covid precautionary measures and less than 35% responses for wrong claims and practices about covid -19.

Conclusion: The overall knowledge, attitude, and perception are high in Enugu state population although few still has background combined superstitious believes. Social media and internet are the highest used facility for acquisition of knowledge and information in Enugu, Nigeria.

Open Access Original Research Article

Role of Serum Cystatin C in Early Diagnosis of Acute Kidney Injury in Neonates with Bronchopulmonary Dysplasia

Sara Mohamed Elashry, Maher Ahmed Abdelhafez, Mostafa Mohamed Awny, Nahed Mohamed Elwan, Hamed Mohamed Elsharkawy

Journal of Advances in Medicine and Medical Research, Page 38-48
DOI: 10.9734/jammr/2021/v33i2031102

Background: The neonate is more susceptible to acute kidney injury (AKI) than others due to functional and developmental immaturity, hemodynamic changes that occur at birth, and possibility of hypovolemia due to increased insensible water losses. The aim of this work was early detection of the occurrence of AKI through measurement of serum cystatin C (CysC) and assessment of renal function in patients with bronchopulmonary dysplasia (BPD) in order to initiate early and appropriate therapeutic measures as indicated.

Methods: This prospective observational study was carried out on 50 neonates diagnosed as cases of BPD with gestational age ranging from 28w to 38w. Urea, creatinine and serum CysC were measured twice, the first measurement was at the time of diagnosis of BPD and the second one was 3 days later with estimation of creatinine based Glomerular filtration rate (GFR) and cystatin based GFR.renal Doppler ultrasound was performed to measure peak systolivc velocity, end diastolic velocity and resistive index.

Results: There were 7 cases with abnormal GFR According to the first creatinine based GFR. There were 16 cases with abnormal GFR according to the first cystatin C based GFR with no statistically significance difference between both measurements. 5 patients were classified to have AKI based on serum creatinine level. There was statistically significant increase in 1st, 2nd serum creatinine, 1st and 2nd serum cystatin C levels in the AKI patients in comparison to non AKI group. On the other hand, there was statistically significant decrease in 1st, 2nd creatinine based GFR, 1st and 2nd cystatin C based GFR. There was statistically significant increase in mortality in the AKI patients if compared to non AKI patient. There was statistically significant increase in SBP, DPB and PCO2 in the AKI patients in comparison to non AKI group.

Conclusions: Measurement of serum CysC and estimation of cystatin based GFR can help in early detection of cases with renal malfunction among the patients with BPD before rise of serum creatinine Early diagnosis will lead to improvement of the outcome and shortening of the hospital stay.

Open Access Original Research Article

High Normal Thyrotropin (TSH) is Associated with Higher Needed Dose of Erythropoietin in Hemodialysis Patients

Ibrahim Ali Abd Elsalam Rady, Mervat Abd Elhamid Elkhateeb, Maaly Mohamed Mabrouk, Noha Elsayed Esheba

Journal of Advances in Medicine and Medical Research, Page 49-55
DOI: 10.9734/jammr/2021/v33i2031103

Background: Recombinant human erythropoietin demonstrated an impressive ability to improve hematocrit, raising hematocrit of hemodialysis patients, eliminating the need for transfusions, and in patients with iron overload, decreased serum ferritin. Thyrotropin could affect hematopoiesis by binding to a functional thyrotropin receptor, which is found in both erythrocytes and some extrathyroidal tissues. The aim of this study was to evaluate the relationship of Thyrotropin level within normal reference range (in euthyroid state) on erythropoietin dose in end-stage renal disease patients on hemodialysis.

Methods: Prospective cross-sectional study was carried out at the hemodialysis units. It included 60 patients who had end-stage renal disease on hemodialysis. The selected patients were classified into 2 groups: Group A: included 30 end-stage renal disease patients on hemodialysis with Thyrotropin level (0.4-<2.5 miu/L) and Group B: included 30 end-stage renal disease patients on hemodialysis with Thyrotropin level (2.5-4.2 miu/L).

Results: the hemoglobin level and the hematocrit level showed a highly statistically significant difference between both groups. The needed Erythropiotin dosage was higher in group B than in group A with highly statistically significant difference. Weighted Erythropiotin dosage was calculated (weighted Erythropiotin=Erythropiotin dosage/weight) and the mean required dose was less than the required dose in group B and there was a highly statistically significant difference between the two groups. There was a significant negative correlation between the Thyrotropin level and hematocrit level and that leads us to conclude that the higher the Thyrotropin, the lower hematocrit will be and subsequently the higher Erythropiotin dose needed.

Conclusions: There is a relationship between Thyrotropin level even within normal reference range (in euthyroid state) on erythropoietin dose in end-stage renal disease patients on hemodialysis. In other words, the higher Thyrotropin level is, the more Erythropiotin dose needed. The required erythropoietin stimulating agent dose can be predicted by measuring Thyrotropin level.

Open Access Original Research Article

Elevated Plasma Fibrinogen and the Risk of Stroke: A Hospital Based Prospective Case-Control Study in Uyo, Nigeria

Timothy A. Ekwere, Olufisayo G. Ayoade, Bertha C. Ekeh, Franklin O. Dike

Journal of Advances in Medicine and Medical Research, Page 56-61
DOI: 10.9734/jammr/2021/v33i2031104

Background: Stroke is one of the leading causes of morbidity and mortality globally. In recent time, there is increasing evidence that suggest that increased plasma fibrinogen is associated with increased risk of stroke with unfavourable clinical outcome.

Objectives: To determine the plasma fibrinogen levels in stroke patients and compare with healthy controls.

Study Design: The study design was Prospective case- control study. 

Place and Duration of Study: The study was conducted in the department of Internal Medicine (Neurology Unit) and the department of Haematology between March to August, 2019.

Methodology: A case- control study consisting of 41 patients (21M: 19F) diagnosed with stroke in line with WHO definition and confirmed by CT-Scan of the brain were recruited consecutively into the study. 20 (10M: 10F) healthy age and gender matched consenting adults were used as controls. Plasma fibrinogen was determined for both the patients and controls using ELISA method. Also, socio-demographic and clinical data were collected using questionnaire designed for the study. The level of significance was set at P=.05.

Results: The mean plasma fibrinogen level of 458.0 ± 89.1 was significantly higher in the stroke patients compared to the controls 307.8 ± 61.5 (P<0.001). An increasing level of plasma fibrinogen was observed with increasing age in both the patients and controls. However, this increase was not statistically significant (P=0.98). Also, the plasma fibrinogen level was significantly higher in the female patients (501.21±83.96) than the males 420.59±77.02 (P=0.003).

Conclusion: Plasma fibrinogen was significantly higher in the stroke patients compared to the controls with female patients having a significantly higher levels than males. Also, the plasma fibrinogen levels appear to increase proportionally with increasing age.

Open Access Original Research Article

Evaluation of Serum Presepsin in the Diagnosis and the Prognosis of Cirrhotic Patients with Ascites

Aziza Mohamed Hamed Zian, Mervat Abd El-Hameed Elkhateeb, Amira Youssef Ahmed, AL Zahraa Abd El-Azeam Allam

Journal of Advances in Medicine and Medical Research, Page 62-69
DOI: 10.9734/jammr/2021/v33i2031105

Background: Liver cirrhosis is a serious problem associated with spontaneous bacterial peritonitis and renal dysfunction. Presepsin is a soluble Cluster of Differentiation 14 (CD14) Protein subtype that has been implicated as an important biomarker in many diseases.

Objective: To assess the clinical value of presepsin as a diagnostic and prognostic marker for spontaneous bacterial peritonitis in cirrhotic patients. 

Patients and Methods: This cross-sectional study was carried out on 60 cirrhotic patients with ascites. The data were collected from Internal Medicine Hospital Inward and ICUs of Internal Medicine.

Results: Serum presepesin had a significant negative correlation with serum albumin (rs = -0.350, p = 0.006) and a significant positive correlation with platelet count (rs =0.547, p < 0.001). In the Spontaneous bacterial peritonitis (SBP) group, presepesin correlated significantly positively with total leukocytic count (rs =0.547, p < 0.001). The level of serum presepsin significantly increased with the group suffering from Hepatorenal syndrome (HRS) than the ascites group after adjusting for age, C-reactive Protein (CRP) level, and total leukocytic count. Similarly, the level of serum presepsin significantly increased with the SBP group than the ascites group after adjusting for age, CRP level, and total leukocytic count.

Conclusion: presepsin is a promising biomarker in the diagnosis of bacterial infections and hepatorenal syndrome in cirrhosis. However, the diagnostic and prognostic value of presepsin needs further studies.

Open Access Original Research Article

Association of Cervical Intraepithelial Lesions in Women with Genital Warts; A Cytological and Molecular Study

Nada S. Fathallah, Ahmed M. Hagras, Safinaz H. El-Shorbagy, Manal M. Abd Allah

Journal of Advances in Medicine and Medical Research, Page 82-92
DOI: 10.9734/jammr/2021/v33i2031107

Background: Cervical cancer is a major health concern worldwide, according to the World Health Organization. It is now the fourth most common cancer after breast, colorectal and lung cancers in women worldwide. It is also the world's third most common cause of cancer death in women. objective of the study is to clarify association between genital warts & cervical intraepithelial lesions using cervical smear cytology with real time PCR.

Methods: The study was carried out at The Department of gynecology & dermatology in Tanta University Hospitals. 50 patients were included started from June 2019 to June 2020.

Results: From June 2019 to June 2020, 50 married women with genital warts are include in the study. Ten women out of 50 were married twice. Number of pregnancies ranged from 0 to 4 with a median (IQR) of 2.56. As regard LSIL group; 6 patients were infected by low risk HPV genotypes while only 2 patients had a mixed infection with high risk HPV genotypes. While all HSIL patients were infected by high risk HPV genotypes.

Conclusions: The cytological characteristics of HPV on cervical smear appear to be non-specific. Therefore, PCR for HPV should be made use of as an adjunct to cervical smears in high risk patients to diagnose and follow up early cervical intraepithelial lesions.

Open Access Original Research Article

Mean Sac Diameter Minus Crown Rump Length as a Predector of Early Pregnancy Outcome

Hasnaa M. Mosbah, Mona K. Omar, Manal F. Hemisa, Elsayed F. Rakha

Journal of Advances in Medicine and Medical Research, Page 93-104
DOI: 10.9734/jammr/2021/v33i2031110

Background: Mean sac diameter (MSD) is a sonographic measurement of the gestational sac which is usually first seen at around 5 weeks, when it measures about 2-3 mm, It's the average of measurements taken in three dimensions.Crown rump length (CRL) defined as the length of the embryo or fetus from the top of it's head to bottom of torso, it's the most accurate estimation of gestational age in early pregnancy, it's determined by the average of three measurements of the longest fetal length. Aim of the study Determine efficacy of mean sac diameter minus crown rump length  (MSD-CRL) in prediction of early pregnancy outcome.

Methods: The study included 80 cases at (6:9) gestational weeks with singletone pregnancy. We examined the case at the initial visit, Mean sac diameter and Crown rump length were calculated for each case. The difference between the MSD and CRL in mm was calculated. Then follow up visit after two weeks later. Pregnancy outcome was then recorded between (11:14w). During transvaginal ultrasound (TVUS) we observed location, size, number and regularity of gestational sac. Cardiac pulsation & Presence or absence of sub-chorionic hematoma.

Results: 73 cases (91, 3%) continued normal pregnancy and 7 cases (8, 8%) had pregnancy failure. It was found that the age, body mass index, gravidity and history of abortion show insignificant relation with outcome (p >0.05).  Area under a curve was 0.984, p Value was <0.001, 95% CI was (0.961 – 1.000), at the cut off value (MSD-CRL) less than or equal 4, the sensitivity was 71.4%, the specificity was 97.2%, PPV was 71.4% and NPV was 97.3%, while at cut off value less than or equal 5, the sensitivity was 100.0%, specificity was 95.89, PPV was 70.0% and NPV was 100.0%.

Conclusions: (MSD- CRL) is good prediction for early pregnancy outcome but, the optimum threshold for predicting pregnancy outcome needed to be established by further studies, also bigger sample size will provide more advantage.

Open Access Original Research Article

The Relation between Iron and Vitamin B12 Status with Coronary Artery Disease

Kholoud M. Shamallakh, Ohood M. Shamallakh, Heba M. Arafat, Mazen M. Alzaharna

Journal of Advances in Medicine and Medical Research, Page 105-115
DOI: 10.9734/jammr/2021/v33i2031112

Aims: To investigate the association of iron and vitamin B12 status with coronary artery disease in Gaza city.

Study Design: A Case control study

Place and Duration of Study: Samples were collected from the cardiac unit at Al-Shifa hospital, Gaza Strip.

Methodology: Case-control study was conducted on a sample of 31 patients with coronary artery disease (CAD) and 27 apparently healthy controls aged between 30-60 years. Interviewed questionnaire was conducted among the study population. Vitamin B12, serum ferritin, serum iron, lipid profile parameters, and high sensitivity C reactive protein were performed. An approval was acquired from Helsinki ethical committee to perform this study. All data were analyzed by SPSS.

Results: The results showed that the mean level of serum iron in cases (71.6 ± 24.7 µg/dl) was lower compared to that of controls (87.3 ± 28.4 µg/dl) and the difference was statistically significant (P=.028). Moreover, transferrin saturation percentage in cases (24.0 ± 8.9%) was lower compared to controls (29.0 ± 9.9%) and the difference was statistically significant (P=.045). In addition, the mean levels of serum vitamin B12 in cases (238.8 ± 51.4 pg‎/dl) was lower compared to controls (337.3± 108.4 pg‎/dl) and was statistically significant (P<0.001). The Pearson correlation test showed that there was a significant positive correlation between the level of serum iron with the level of vitamin B12 among the participants (r = 0.28, P=.032).

Conclusion: The mean differences of transferrin saturation, serum ferritin, and vitamin B12 between cases and controls were statistically significant. The mean levels of serum vitamin B12 in cases was lower compared to controls and was statistically significant.

Open Access Original Research Article

Early Uterine and Umbilical Artery Doppler Indices as Predictor for Preeclampsia and Intrauterine Growth Restriction

Sara E. Khalil, Mohammed M. Elnamory, Mona k. omar, Hesham M. Eltokhy

Journal of Advances in Medicine and Medical Research, Page 116-126
DOI: 10.9734/jammr/2021/v33i2031113

Background: Preeclampsia (PE) is a disorder that causes hypertension and proteinuria after week 20 of pregnancy. Several Uterine Artery (UtAs) Doppler characteristics have been investigated for their ability to predict PE. The purpose of this research is to look into the uterine and umbilical arterial Doppler indices in the early second trimester for the prediction of late preeclampsia or intrauterine growth restriction.

Methods: This is a prospective cohort clinical study and was done at Obstetrics and Gynecology department, faculty of medicine Tanta university hospital from January 2020 till April 2021. 150 pregnant women aged from 18 to 30 years old with gestational age from 13 to 16 weeks of pregnancy. Study was done by the same observer by machine MINDRAY DC60 Measurement of fetal biometry (BPD, FL, AC, HC) Gestational age was confirmed with Detection of congenital malformation.   

Results: There is a significant difference between the groups regarding uterine and umbilical artery doppler Indices. Uterine RI only yielded significance for predicting IUGR with sensitivity of 62% and specificity of 88%, with Positive predictive value (PPV) 37% and Negative predictive value (NPV) 92%. Umbilical resistance index achieved sensitivity of 56% and specificity of 82%, with PPV 31% and NPV 30% with on statistical significance.

Conclusions: Combination of uterine and umbilical artery Doppler study in early pregnancy is one of the best indicator for prediction of preeclampsia and IUGR. Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.

Open Access Original Research Article

Comparison between Laparoscopic and Open Repair of Umbilical and Paraumbilical Hernia: A Randomized Controlled Trial Study

Arti Mitra, Unmed Chandak, Shiv Kumar Sahu, Yuvraj Pawaskar, Akanksha Waldia

Journal of Advances in Medicine and Medical Research, Page 127-135
DOI: 10.9734/jammr/2021/v33i2031114

Background: Laparoscopic repair of umbilical and paraumbilical hernia has largely replaced conventional (Open) repair. The purpose of the study was to compare the effectiveness of laparoscopic vs. open repair of umbilical & para umbilical hernia in a tertiary care government hospital.

Methods: A total 50 patients of age >18 years diagnosed with umbilical and paraumbilical hernia who underwent laparoscopic and open hernia repair from May2018 to Nov 2020 were enrolled and divided into two groups of 25 patients in each. The patients were followed up in the post-operative period in the wards during daily rounds till the time of discharge; 1 and 6 months after discharge and yearly.

Results: The mean age for open group was 44.24±7.68years while the mean age for laparoscopic group was 50.0±11.82years. Operative time was more in laparoscopic repair (81.68±18.37min) as compared to open (55.44±16.54min). Post-operative pain (VAS score) was greatest in the open group in comparison to lap group at 6 hr, 24 hr, day 8 and at 1month. Postoperative overall complication rate (Infection, seroma and recurrence) was 12% in the laparoscopic group and 28% in the open group. Recovery was faster with laparoscopic repair with a mean postoperative hospital stay of 3.28days as compared to 5.88days for open mesh repair. Patients treated with laparoscopic repair were early return to routine activity and work.

Conclusion: The laparoscopic approach appears to be safe, effective and acceptable. It is a complex but very efficient method in experienced hands and it offered a significant advantage over open repair.

Open Access Original Research Article

Diabetes Mellitus as a Risk Factor for Drug Resistance Tuberculosis: A Retrospective Cohort Study at King Abdul Aziz University, Jeddah

Sumyia Mehrin M. D. Abulkalam, Mai Kadi, Mahmoud A. Gaddoury, Wallaa Khalid Albishi

Journal of Advances in Medicine and Medical Research, Page 136-145
DOI: 10.9734/jammr/2021/v33i2031115

Background: The association between tuberculosis (TB) and diabetes mellitus (DM) is re-emerging with the epidemic of type II diabetes. Both TB and DM were of the top 10 causes of death.[1] This study explores diabetes mellitus as a risk factor for developing the different antitubercular drug-resistant (DR) patterns among TB patients. 

Methods: A retrospective cohort study has been conducted on all TB cases reported to the King Abdul Aziz University Hospital, Jeddah, between January 2012 to January 2021. All culture-confirmed and PCR-positive TB cases were included in this study. Categorical baseline characteristic of TB patient has been compared with DM status by using Fisher's exact and Pearson chi-square test. The univariable and multivariable logistic regression model was used to estimate the association between DM and different drug resistance patterns. 

Results: Of the total 695 diagnosed TB patients, 92 (13.24%) are resistant to 1st line anti TB drugs. Among 92 DR-TB patients, 36 (39.13%) are diabetic. The percentage of different patterns of DR-TB with DM, in the case of mono DR (12.09%), poly DR (4.19%) MDR (0.547%). As a risk factor, DM has a significant association with DR-TB, mono drug-resistant, and pyrazinamide-resistant TB (P-value <0.05). The MDR and PDR separately do not show any significant association with DM, but for further analysis, it shows a significant association with DM when we combined. 

Conclusion: Our study identified diabetes mellitus as a risk factor for developing DR-TB. Better management of DM and TB infection caring programs among DM patients might improve TB control and prevent DR-TB development in KSA.

Open Access Original Research Article

The Pattern of Common Cholesterol Fractions in Stroke Patients

Ijoma Uchenna Nkemdilim, A. Ezeala-Adikaibe Birinus, Ekochin Fintan, Innocent Chukwuemeka Okoye, Onodugo Nkiru Pauline, Ekwe Esther, Onodugo Obinna

Journal of Advances in Medicine and Medical Research, Page 146-154
DOI: 10.9734/jammr/2021/v33i1031116

Aims/Purpose: The aim of this study was therefore to document the frequency and pattern of serum cholesterol in stroke patients admitted in a tertiary hospital in Enugu.

Methods: This was a descriptive cross-sectional study carried out at Enugu State University Teaching Hospital Enugu. Serum cholesterol levels were classified based on the current international cut off points for people with cardiovascular disease. Statistical analysis of data was carried out using SPSS version 22.

Results: Data from a total of 180 subjects were collected and analyzed. The mean (sd) of serum cholesterol fractions and their distributions are: Low density lipoprotein 2.4± 1.18 mmol/l, High density lipoprotein, 1.17± 0.62 mmol/l, Total Cholesterol, 4.43± 1.34 mmol/l, and triglycerides 1.21±0.77 mmol/L. HDL-cholesterol was significantly lower in patients 50 years and older. P=0.02. A total of 12 (6.7%) of the patients had high levels of LDL, 92(51.1%) had poor levels of HDL. Between stroke types, 10(7.2%) of patients with ischemic stroke had high serum LDL compared to 2(4.8%) with hemorrhagic stroke p= 0.32. Among those with hemorrhagic stroke, 22(52.4%) had poor levels of HDL compared to 70(50.7%) of those with ischemic stroke p= 0.17. Total cholesterol and triglycerides were also found in a higher proportion of those with ischemic stroke than hemorrhagic although these differences were not statistically significant.

Conclusions: There mean level of serum LDL, HDL and TC are higher in stroke patients than recommended values. Current recommended universal use of statins after stroke should be encouraged in both ischemic and hemorrhagic stroke.

Open Access Original Research Article

Role of CT Angiography in Diagnosis of Reno-Vascular Abnormalities

Diaa Mustafa Ismail Marei, Rasha Mahmoud Dawoud, Ghada Mahmoud Al Ghazaly, Abdelmonem Nooman Darwesh

Journal of Advances in Medicine and Medical Research, Page 155-161
DOI: 10.9734/jammr/2021/v33i2031117

Background: Reno-vascular disease is a complex disorder, the most common cause of which is RAS. Multi detector computed tomography angiography (MDCTA) plays an important role in assessment of the renal vasculature. Despite conventional angiography is still considered the gold standard in reno-vascular imaging, MDCTA is increasingly used as it is less invasive, easily applicable and available.

Aim of the Study: In our study we aimed to assess the role of CT Angiography in diagnosis of renal vasculature abnormalities.

Patients and Methods: This prospective study was carried out at The Radio-diagnosis and Medical Imaging Department in our institute, conducted on 40 Patients who are clinically suspected to have reno-vascular abnormalities in the period from September 2018 to February 2021. Their ages ranged from 33 to 56 years old.

Results: Based on CTA findings, out of 40 patients, 6 (15%) patients were confirmed to have accessory renal arteries, 6 (15%) patients had renal artery aneurysm, 6 (15%) patients had nutcracker syndrome, 6 (15%) patients had dual venous drainage of both kidneys, two of them showed retro-aortic left renal vein &10 (25%) patients were confirmed to have renal artery stenosis.

Conclusion: CT Angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with reno-vascular lesions involving the proximal renal vessels. MDCT angiography is advantageous being a non-invasive technique that can be done on outpatient basis without pre or post-procedure admission, no special post-procedure care and less cost.

Open Access Original Research Article

The Potential of Differentiation-Related Gene-1 (DRG1) as a Biomarker for Metastasis of Estrogen Receptor-Positive Breast Cancer

Hillary Bor, Esther N. Maina, Benson Nyambega, Kirtika Tushar Patel, Charles Ochieng’ Olwal, Walter Nalyanya, Yahaya Gavamukulya

Journal of Advances in Medicine and Medical Research, Page 162-169
DOI: 10.9734/jammr/2021/v33i2031118

Introduction: Breast cancer is major burden worldwide and the majority of breast cancers express estrogen receptors (ER) suggesting a high dependence on estrogen hormone. Age is among the major determinants of breast cancer development, however, although Western Kenya is one of the areas with high breast cancer cases, age distribution of ER-positive breast cancer in the sub-region remains largely undocumented. Differentiation-related gene-1 (DRG1) is a metastasis suppressor and thus a potential biomarker for predicting level of metastasis but its potential application in assessing extent of metastasis of ER positive breast cancer has not been fully explored. This study therefore investigated the age distribution and the potential of expression of DRG1 in assessing metastasis of ER positive breast cancer.

Materials and Methods: Breast cancer tumour blocks archived in safe cabins in the histology laboratory section, Moi Teaching and Referral hospital, Eldoret, Kenya were used. Clinico-pathological parameters such as histology grade, tumor size, which are associated with metastatic cancer, were assessed using the archived clinico-pathological reports and/or histological analysis of the tumour blocks. Expression of DRG1 and Ki-67 proteins were determined using immunohistochemistry.

Results: ER positive breast cancer was predominant among women aged 40 and 50 years. No association was observed between immunohistochemical expression of DRG1 and parameters such as histology grade, tumor size or expression of Ki-67 protein expressed DRG1 (p > 0.05).

Conclusion: The findings suggest that expression of DRG1 protein is not associated with parameters that indicate breast cancer metastasis. Thus, DRG1 expression is not a potential biomarker candidate for ER positive breast cancer metastasis. However, since the small sample size was used, further research using larger prospective study is necessary to support the present findings.

Open Access Original Research Article

Efficacy of Hysteroscopy in the Diagnosis if Chronic Endometritis in Infertile Females

Nancy Diab Mousbah, Mona Khalid Omar, Hassan Tahsin Shoeir, Ahmed Hussien Abou Freikha

Journal of Advances in Medicine and Medical Research, Page 199-210
DOI: 10.9734/jammr/2021/v33i2031122

Background: Chronic endometritis (CE) is a chronic inflammatory condition characterized by the presence of plasma cells in endometrial stroma. CE is a subtle disease, often overlooked by clinicians due to poor symptomatology, such as uterine bleeding, pelvic discomfort, dyspareunia, and leucorrhoea.

Methods: This cohort prospective study was conducted at Tanta University hospitals aiming to evaluate the efficacy of hysteroscopy in the diagnosis of chronic endometritis in infertile females. We included a total of 80 infertile females who were subjected to complete history taking, general examination, and complete gynaecological investigations. Routine laboratory parameters were also performed. In addition, hysteroscopic examination was performed for all cases with endometrial biopsy.

Results: Our results showed that the mean age of the included cases was 26.6 years (range, 20 – 36), the mean BMI of the included cases was 30.51 kg/m2, Hysteroscopic examination revealed endometrial hyperemia (85.4%), stromal edema (52.1%), and endometrial polyps (43.75%), Hysteroscopic diagnosis of chronic endometritis was established in 48 cases (60%). Nevertheless, pathological examination confirmed the diagnosis only in 33 cases (41.25%), Hysteroscopy had sensitivity and specificity of 81.89 and 55.3% respectively, with an accuracy of 66.25% in detecting chronic endometritis, Agreement between hysteroscopic and pathological had kappa factor of 0.325 (p = 0.004), On immunohistochemical analysis of chronic endometritis specimens, CD138 was positive in 31out of 33 cases (93.93%).

Conclusions: Office hysteroscopy is a reliable examination for investigating chronic endometritis. It could be useful for screening asymptomatic infertile patients. The chronic endometritis is a hidden condition that is difficult to detect with non-invasive examination, we suggest that hysteroscopy should be always performed in the diagnostic work-up of women with unexplained infertility, especially before starting assisted reproduction procedures. Also, endoscopic samples should be obtained during hysteroscopy to increase the diagnostic accuracy.

Open Access Original Research Article

CD4 and CXCR5 in Patients with Diabetic Nephropathy

Sara Zaghloul Abdelhameed, Wesam Salah Mohamed, Kamal Mohamed Okasha, Mohamed Kamal Zahra

Journal of Advances in Medicine and Medical Research, Page 211-218
DOI: 10.9734/jammr/2021/v33i2031123

Background: Diabetes is a metabolic condition characterized by hyperglycemia caused by defects in insulin secretion, insulin activity, or both. Diabetic nephropathy (DN) is one of the most common complications of diabetes mellitus especially type 2 diabetes. Blood CXCR5+CD4+ T cells represent three subsets: T follicular helper 1 (Tfh1), Tfh2 and Tfh17 cells. Increasing the numbers of circulating Tfh cells and also stimulation of Tfh cells have been linked with autoimmune diseases and may have a role in pathogenesis of diabetic nephropathy.

Aim of the Work: Was to investigate CD4 and CXCR5 in diabetic nephropathy patients and assess their role in the pathogenesis of diabetic nephropathy.

Subject and Methods: This study was conducted on 20 diabetic patients without nephropathy (Group I), 20 diabetic nephropathy patients (Group II) and 20 apparently healthy control subjects (Group III). Complete history taking and full clinical examination were done. Assessments of CD4 and CXCR5 were done by flowcytometry (FACS caliber, BD, CA, USA).

Results: The present study revealed a statistically significant difference between diabetic patients (Group I), diabetic nephropathy patients (Group II) and healthy control (Group III) regarding CD4+CXCR5+T follicular helper cells level. CD4+CXCR5+T follicular helper cells levels were significantly higher in diabetic nephropathy patients than in diabetic patients without nephropathy and control subjects. CD4+CXCR5+T follicular helper cells level positively correlated significantly with fasting blood glucose, postprandial blood glucose, hemoglobin A1c, creatinine, urea and urinary protein level, and negatively correlated with estimated GFR in diabetic nephropathy patients.

Conclusions: This study showed that CD4+CXCR5+T follicular helper cells level might be a useful marker for prediction and diagnosis of diabetic nephropathy patients.

Open Access Original Research Article

Co-Relation of Ocular Fundus Changes and Pregnancy Induced Hypertension and Its Foetal Outcomes

Mohmed Kandeel, Hoda El-Sobky, Ahmed Shalah, Essam A. Amin

Journal of Advances in Medicine and Medical Research, Page 219-228
DOI: 10.9734/jammr/2021/v33i2031124

Background: Pregnancy-Induced Hypertension (PIH) is a stigmatizing condition in obstetrics and a significant cause of maternal and neonatal death. It is a kind of pregnancy-related hypertension that develops after 20th week of pregnancy with no presence of other reasons of high blood pressure.

Objectives: To study the relation between grades of ocular fundus changes& degree of features severity of pregnancy induced hypertension and its maternal and foetal outcomes.

Subjects and Methods: This is a prospective observational follow up study, the research lasted about 16 months and included 121 pregnant women diagnosed with PIH. Ocular examinations were performed using a direct ophthalmoscope, a slit lamp and grades of retinopathy were recorded and linked to the severity of PIH and its consequences. The data were analyzed statistically.

Results: Results of the study revealed that most of the patients 62% had no abnormal fundus changes while 29.8% of the patients were grade I retinopathy and 7.4% of the patients were grade II retinopathy & There was significant difference between grades of retinopathy and degree of features of severity of PIH & some of its important maternal & foetal outcomes.

Conclusion: Grades of ocular fundus alterations are associated with the severity of PIH's characteristics and are predictive of maternal and fetal comorbidity.

Open Access Original Research Article

Role of Point of Care Ultra Sound (POCUS) in Assessment of Fluid Resuscitation in Septic Patients

Sohier Fouad, Nagat Elshamaa, Ghada El-Baradey, Hala Elgendy

Journal of Advances in Medicine and Medical Research, Page 242-248
DOI: 10.9734/jammr/2021/v33i2031127

Background: Initial fluid resuscitation in sepsis must be guided by clinical judgment based on ongoing reevaluation of the hemodynamic status (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output) and ultrasound measurements (stroke volume, cardiac output, lung ultrasound and inferior vena cava diameter) as positive fluid balance is harmful.

Methods: Adults Patients (≥ 18 years old) with symptoms or signs of tissue hypoperfusion (Sequential organ failure assessment score SOFA≥ 2) are included. Patients with elevated intra-abdominal pressure (as, ascites, pregnancy), Recent abdominal operation, cannot lie flat, Patient on mechanical ventilation and patients with valvular heart disease were excluded. IVC CI, SV, COP and B mean score were measured on patient arrival and after every 10 ml/kg isotonic saline over the first hour of patient arrival. Thereafter, patients were divided into two groups high caval index and low caval index according to inferior vena cava collapsibility index.

Results: Among our 50 patients,38% of patients were with high caval index and 62% have low caval index.

Conclusion: POCUS has additive value in guiding of fluid resuscitation in sepsis in order to avoid fluid overload and to identify proper timing of vasopressor use.