Open Access Systematic Review Article

Mental Health of Pregnant Women during Covid-19: A Systematic Review Study

God’s Favour Adediran, Derma Dupuis, Kasinda Fritz, Olebogeng Leso, Emeka Ike, Olugbenga Morebise

Journal of Advances in Medicine and Medical Research, Page 156-174
DOI: 10.9734/jammr/2021/v33i2131145

Background: The novel coronavirus (COVID-19) pandemic has created avenues for physical and mental stress on individuals worldwide.  Pregnant women especially, with the onset of COVID-19 have been challenged greatly by an array of disorders, all with varying cognitive, emotional, and behavioral responses.  The aim of our research is to conduct a review of the different mental health issues experienced by pregnant women in various geographical locations and analyze the prevalence of specific mental issues.

Materials and Methods: A mixed-methods systematic review was conducted.  Databases PubMed, Google Scholar, BioMed Central, CrossRef and British Medical Journal were thoroughly examined by the authors for the purpose of locating the relevant articles as per specific geographical location. 

Results: From the applicable studies identified, twenty-eight (28) were selected for review.  As per the North American studies, levels of depression and anxiety in pregnant women at and around the time of the pandemic ranged from 33.2 to 70%.  This differs in European countries where there were levels of 14.0 to 60%. Prevalence of stress among pregnant women in Asia was 32.7% while 17% of North American women reported the same. In the studies of Australia and South America, the prevalence of anxiety ranged 6% to 13.9% while studies in Africa reported severe and extremely stress, 7.2% (n=33) and 64% (n=29) respectively.

Conclusion: The prevalence of depression and anxiety among pregnant women was shown to be relatively high in all regions as per the COVID-19 pandemic, owing to many factors.  Based on the studies analyzed, adequate support, resources and better healthcare systems are imperative for ensuring that depression and anxiety levels be reduced among this demographic.  

Open Access Systematic Review Article

The Effect of COVID-19 on the Mental Health of Healthcare Workers: A Systematic Review

Consolata Uzzi, Bolaji Yoade, Victoria Iyanu Olateju, Mary Olowere, Gibson Anugwom, Mathew Owolabi, Alexsandra Urhi, Hafiz Olatunde, Fasina Feyikemi, Oluwafemi Akinbode, Dolly Ogwu, Funso Oladunjoye

Journal of Advances in Medicine and Medical Research, Page 183-194
DOI: 10.9734/jammr/2021/v33i2131147

Background: As COVID-19 pandemic continues to affect every nation, Healthcare Workers (HCW) who care for the patients are psychologically impacted. This study aims to assess the psychological impact experienced by HCW and the psychosocial support they received.

Methods: Using PubMed, google scholar and Embase from December 2019 through June 2021, we found 376 studies on the impact of the COVID-19 pandemic on the mental health of HCW. Using our inclusion criteria, 325 studies were excluded. 51 full-text articles were assessed for eligibility. 9 articles which met our criteria and eligibility criteria reported on 19,232 HCW, and 75.2% of the study participants were women.

Results: The study participants reported high levels of stress, hypervigilance, fatigue, sleep problems, PTSD symptoms, poor concentration, depression, anxiety, burnout, emotional exhaustion, depersonalization, suicide and self-harm ideations and somatic symptoms due to the COVID-19 pandemic. The psychosocial support provided to HCW includes counseling and psychotherapy-based sessions on stress adaptation, onsite mindfulness-based crisis intervention, online form of emotional freedom technique, and Effort-reward system. 

Conclusion: Multiple interventions found in our review were effective in mitigating psychological stress among HCWs. These interventions should be considered as part of support provided to HCW with psychosocial challenges.

Open Access Case Study

Kernohan-Woltman Notch Phenomenon in Chronic Subdural Hematoma: An under-Diagnosed Phenomenon?

M. Asante-Bremang, B. A. B. Alhassan, E. O. Ofori, S. Yussif, K. Agyen-Mensah, G. A. Rahman, P. K. Mbroh, K. M. Edzie

Journal of Advances in Medicine and Medical Research, Page 115-123
DOI: 10.9734/jammr/2021/v33i2131139

Introduction: Kernohan-Woltman notch phenomenon is a neurological picture of mydriasis and hemiparesis/ hemiplegia ipsilateral to a supratentorial mass lesion causing compression of the contralateral cerebral peduncle against the tentorial edge.  The aim of this paper is to report  series of cases from a low volume centre of neurosurgical care and highlight the fact that Kernohan’s notch phenomenon, although, reported to be quite rare but it’s not uncommon and to also look out for this phenomenon to avoid wrong site surgeries. 

Presentation of Cases: We report four cases of chronic subdural hematoma presenting with Kernohan- Woltmann notch phenomenon. The patients include: a young alcoholic who was found in a gutter after binge drinking, a middle aged man who was accidentally hit on the head with a car tire jack, an elderly female with no history of trauma, a fall nor use of anticoagulant and an elderly male, a diabetic. All four patients had emergency burr hole and drainage of subdural hematoma.  

Discussion: This incidence of this phenomenon among patients with chronic subdural hematoma is rarely reported in the literature, however, a low volume centre for neurosurgical services like ours has seen five cases in a short period of time.  

Conclusion: This paradoxical neurological sign is probably under-diagnosed judging from the number of cases diagnosed in a low volume center like ours.

Open Access Short Communication

Management of Diabetic Retinopathy

Marieta Dumitrache, Rodica Lascu

Journal of Advances in Medicine and Medical Research, Page 95-103
DOI: 10.9734/jammr/2021/v33i2131137

Management in D.R. through prophylactic treatment (maintaining a glycemic level as close as possible to normal, control hypertension <150/85 mmHg, hyperlipidemia) and curative treatment of D.R. does not cure the disease, but may slow the evolution of D.M. and D.R. AntiVEGF agents are indicated as adjuvant therapy in pan-photocoagulation laser and / or vitrectomy in patients with DR to block angiogenesis by inhibiting VEGF. All antiVEGF agents are an effective treatment for the clinically significant macular edema. Photocoagulation laser is a treatment of choice in preproliferative and proliferative DR and an effective treatment of diabetic macular edema. The indications for laser treatment in diabetic retinopathy are related to the incidence, evolution of neovessels, duration of diabetes, HbA1c level, presence of macular edema, stage of DR. The laser for macular lesions reduces the risk of vision loss in the eyes with incipient and moderate non-proliferative DR and macular edema concomitant; the laser should be applied to all patients with clinically significant macular edema. Vitrectomy in proliferative DR is indicated in vitreous hemorrhage, tractional retinal detachment in order to remove the vitreous hermorrhage and excision of tractional preretinal membranes.

Open Access Minireview Article

Colostomies: A Brief Review

Dilce dos Santos Marques, Bruna Rodrigues Andrade, Dhelfeson Wyllia Douglas de Oliveira, Flaviana Dornela Verli, Sandra Aparecida Marinho

Journal of Advances in Medicine and Medical Research, Page 33-38
DOI: 10.9734/jammr/2021/v33i2131131

Aims: To carry out a brief review of the literature on the theme of ostomy, focusing on colostomies.

Study Design: A review study.

Methodology: The papers, in English, Portuguese and Spanish were collected in Scielo database in January 2021. After reading the abstracts, a selection of papers related to the theme was made. Full-text papers that were not available were excluded.

Results: Twenty papers and three books were used. It was observed that ostomized patients show changes in their routines and they also presents body changes, due to the stoma attached to the abdomen. Other problems of these patients were: discomfort with physical appearance, lack of control over noise caused by bowel movements and gases elimination, the possibility of leakage of fecal content, as well as rejection and shame of the new image. Colostomized patients need special care, such as psychological and family supports, to improve their self-esteem, as well as an orientation to colostomy devices use and their periodical hygiene, which should be provided by the multidisciplinary health team. In addition, the team must encourage the patients to avoid social isolation, in order to improve their self-esteem and quality of life.

Conclusion: The use of the stoma leads the ostomized patient to a social isolation, alterations in sexual life and changes in lifestyle, which causes worse quality of life for these patients.

Open Access Original Research Article

Effect of Intravenous Acetaminophen and Flurbiprofen on Postoperative Pain after Lumbar Disc Surgery

Maki Ono, Yoshiaki Terao, Yuya Komatsu, Ayako Shimazaki, Natsuko Oji, Makito Oji

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2021/v33i2131126

Aims: Lumbar disc surgery is often associated with moderate to severe postoperative pain. Whether non-steroidal anti-inflammatory drugs or acetaminophen provides effective analgesia following lumbar disc surgery remains controversial. This study aimed to determine whether flurbiprofen produces analgesic effects equivalent to those of acetaminophen after lumbar disc surgery.

Study Design: Prospective, randomized, open-label, placebo-controlled trial

Place and Duration of Study: Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo, Japan, between April 2018 and March 2019.

Methodology: We studied 76 patients who underwent elective lumbar disc surgery under general anesthesia. The patients were randomly allocated to one of three groups. Group A (n=25) received 1000 mg of acetaminophen intravenously every 6 h. Group F (n=25) received 50 mg of flurbiprofen intravenously every 6 h. Group C (n=26) received saline intravenously every 6 h as a placebo. Each drug was started before skin closure 18 h after surgery. All patients were anesthetized under total intravenous anesthesia with propofol and remifentanil and received fentanyl before skin closure. Postoperative pain was evaluated using a numerical rating scale (NRS) at 0, 1, 3, 6, 12, 18, and 24 h postoperatively. The patients were administered diclofenac sodium or loxoprofen, as rescue analgesics, as needed.

Results: There were no significant differences in patient characteristics among the three groups. There were no significant differences in NRS scores among the three groups during the study period. However, rescue analgesics were administered significantly less frequently in group F than in groups A and C over 12 h and 24 h, respectively.

Conclusion: The results of this study showed that flurbiprofen might provide more effective analgesia than acetaminophen following lumbar disc surgery.

Open Access Original Research Article

Mycoplasma pneumoniae Infections in a Tertiary Care Hospital

Harun Agca

Journal of Advances in Medicine and Medical Research, Page 8-14
DOI: 10.9734/jammr/2021/v33i2131128

Background: Mycoplasma pneumoniae is a common causative agent of community-acquired and atypical pneumonia. M. pneumoniae-associated respiratory tract infections are most often mild and self-limiting in nature, and severe courses of disease are not common.

Aims and Objectives: We aimed to analyze respiratory samples of hospitalized patients by real-time (RT) PCR for M. pneumoniae infections.

Methodology: In this study, hospitalized patients with respiratory symptoms including nasal congestion, rhinorrhea, nasal discharge, wheezing, sore throat and cough, were tested for Mycoplasma pneumoniae between April 2018 and March 2020 and the results of these patients were analyzed retrospectively.

Results: We retrospectively investigated the results of 1245 nasopharyngeal swab samples. Records of 693 (55.7%) male and 552 (44.3%) female patients between 0-93 years were investigated.All of the patients were below 26 years. There were 37 M. pneumoniae positive patients and the highest M. pneumoniae positivity was in 2-5 age group, with 16 children. M. pneumoniae positivity rate was highest in the 0-1 age group with 8.3%. There were 19 co-infections with viruses and rhino/enterovirus (n=12) was the most frequent accompanying virus.

Conclusion: M. pneumonia infections are found in about 3% of respiratory samples. M. pneumoniae is usually a part of co-infections accompanied by bacteria and viruses. Patients with respiratory infection symptoms should be diagnosed with multiplex rapid PCR panels including M. pneumoniae.

Open Access Original Research Article

Anatomical Evaluation of Mandibular Bone Cortex in Patients with Mucopolysaccharidosis: A Case-Control Study

Cledinaldo Lira Junior, Diego Henrique Pires Gonçalves, Kamilly de Lourdes Ramalho Frazão, Sandra Aparecida Marinho, Sérgio Henrique Gonçalves de Carvalho, Gustavo Pina Godoy, Fátima Roneiva Alves Fonseca, Dmitry José de Santana Sarmento

Journal of Advances in Medicine and Medical Research, Page 15-22
DOI: 10.9734/jammr/2021/v33i2131129

Aims: To evaluate the mandibular bone cortical of patients with mucopolysaccharidosis on panoramic radiograph, through radiomorfometric indices.

Study Design: Case-control study.

Place and Duration of Study: Sample: Department of Diagnostic Imaging of the Universidade Estadual da Paraíba, Campus VIII, in the city of Araruna, PB, between January and December of 2015.

Methodology: Panoramic radiographs of sixteen patients with mucopolysaccharidosis and 32 controls, organized by gender and age, composed the sample. The mandibular panoramic index, gonial index, antegonial index and mental index were evaluated. Pearson's Chi-square test, Fisher's exact test and Mann-Whitney test were used to statistical analysis with a level of significance of 5.0%.

Results: Mucopolysaccharidosis patients were mostly female (62.5%), with a mean age of 12.31 + 7.16 years, MPS VI (50.0%) being the most prevalent. Patients with mucopolysaccharidosis had higher values in the gonial (1.86+0.48), the antegonical (4.36+1.24) and the mental (5.24+1.21). However, only the antegoniac index presented a significant difference (P=0.047).

Conclusion: The antegoniac index was higher in patients with mucopolysaccharidosis and the other radiomorphometric measures were similar to those observed in the control group. Apparently, mucopolysaccharidosis is not related to decreased bone to mandibular quality.

Open Access Original Research Article

Ultrasound Guided Femoral Nerve Block with Bupivacaine versus Bupivacaine and Tramadol for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty under Spinal Anesthesia

Mohammad Mostafa Abo Farrag, Laila Elahwal, Hesham Mohammad Maroof ElDomairy, Mohammad Ibrahem Okab

Journal of Advances in Medicine and Medical Research, Page 23-32
DOI: 10.9734/jammr/2021/v33i2131130

Background: Effective pain control in Total knee arthroplasty (TKA) is important for optimizing the rehabilitation process in order to achieve patient satisfaction with a good functional outcome as well as reduce hospitalization duration and costs. Combined use of aesthetic with tramadol has been reported to achieve a longer duration of sensory and motor block. The aim of this study is to evaluate the quality and duration of postoperative analgesia produced by ultrasound guided femoral nerve block (FNB) by bupivacaine versus (bupivacaine & tramadol) in patients undergoing total knee arthroplasty under spinal anesthesia.

Methods: This prospective randomized controlled double blinded study was carried out on 60 patients aged above 50 years; American Society of Anesthesiologists physical status (ASA) I-III scheduled for total knee arthroplasty under spinal anesthesia. Patients were randomized to one of two equal groups: Group I control (C): received FNB with 30 ml 0.25% bupivacaine. Group II tramadol (T): received FNB with 30ml 0.25% bupivacaine and 100 mg tramadol.

Results: Postoperative heart rate was significantly increased in group C than group T at 8h, 12h, 16h and 24h. Postoperative mean arterial blood pressure was significantly increased in group C than group T at 6h, 8h, 12h, 16h and 24h. There were 30 (100%) patients required rescue analgesia in group C and 19 (63.33%) patients in group T which was increased significantly in group C than group T. The time to first analgesic requirement was significantly decreased in group C than group T. Total morphine consumption was increased significantly in group C than group T. VAS was increased significantly in group C than group T at 6, 8, 12, 16 and 24 hours. Adverse effects were insignificantly different between both groups.

Conclusion: Adding tramadol (100 mg) to 0.25% bupivacaine (to a volume of 30 ml) during US guided FNB of TKA under spinal anesthesia was associated with better postoperative analgesia when compared with 0.25% bupivacaine alone.

Open Access Original Research Article

The Influence of Smoking on Choroidal, Macular and Retinal Nerve Fiber Layer Thickness

Mona Ahmed El Rokh, Raouf Ahmed Gaber, Elsaed Ebrahem Eldesoky, Hamouda Hamdy Ghoraba

Journal of Advances in Medicine and Medical Research, Page 46-55
DOI: 10.9734/jammr/2021/v33i2131133

Background: Smoking is one of the most serious health hazards because it affects every organ in our bodies. Cigarette smoking increases the chance of developing systemic and ocular vascular diseases significantly. Although the exact mechanism behind the association between ocular vascular disorders and smoking are unknown, the peripheral vasoconstriction action of nicotine is believed to lead to an increase in peripheral blood flow resistance. This study was designed to examine the impact of smoking with Spectral Domain Optical Coherence Tomography (SD-OCT) on the peripapillary retinal nerve fibre (RNFL), macular, and choroidal thickness.

Methods: This prospective study was done on 50. It included 25 healthy cigarette smokers with no systemic or ocular illness and another 25 age- and gender-matched healthy non-smokers.

Results: The smoking group had a substantial reduction in central macular and choroidal thickness as compared to the nonsmoker group. The RNFL peripapillary thickness across groups was not significantly altered, with the exception of the temporal (T) quadrant which was significantly thinner in the smoking group. This study discovered a substantial negative correlation between peripapillary RNFL, central macular thickness, and smoking exposure.

Conclusions: Smoking reduces the mean thickness of the peripapillary retinal nerve fibre layer (particularly in the temporal quadrant), the choroidal layer, and the central macular layer statistically significantly.

Open Access Original Research Article

Quality of Life among Patients with Chronic Venous Disease (CVD) as Measured by the VEINES-QOL/SYM and the EuroQol-5D-5L Questionnaires, A Descriptive-Comparative Design Study

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

Journal of Advances in Medicine and Medical Research, Page 56-71
DOI: 10.9734/jammr/2021/v33i2131134

Objective: To determine the efficacy (sensitivity, specificity, and accuracy) of the VeinesQol/Sym with metric statements fewer than the EQ5D in detecting the quality of life of patients with Chronic Venous Disease (CVD) before and after treatment.

Methods: This is a descriptive-comparative design in collecting the necessary data to arrive at conclusions that respond to the specific questions of the study in 2 private hospitals. The responses gathered from patients through EQ5D and VeinesQol/Sym, before and after they received treatment were utilized in describing and comparing the efficacy of the health questionnaires.  Data were further subjected to a comparative analysis to elaborate the efficacy of the VeinesQol/Sym. 

Results: A total of 114 CVD patients completed the study after the exclusion of 13 patients due to failure to follow up after eight weeks of treatment. The study showed that VeinesQol/Sym and EQ5D has similar efficacy in determining quality of life of CVD patients. However, VeinesQol/Sym  has higher accuracy (84.96% vs 76.99%), higher sensitivity (87.85% vs 83.87%), detects greater level of impairment in mobility, anxiety/depression, pain and discomfort, disruptions in usual activity and lower quality of current state of health condition than EQ5D

Conclusion: With the responses to the metric statements of the indicators of quality life in both VeinesQol/Sym and EQ5D, VeinesQol/Sym was found to have a greater efficacy in establishing the accurate status of quality of life of patients with CVD than the EQ5D.

Open Access Original Research Article

Fruit Ripening Methods and Knowledge of Health Effect of Use of Calcium Carbide in Ripening Fruits among Fruit Sellers in Uyo, Nigeria

Anyiekere Morgan Ekanem, Wisdom Nicholas Sylvanus, Queendolene Etim Asanana, Imo-Owo Ibanga Akpabio, Etim Isaac Clement, Chidi Kenneth Okpara, Bassey EkponoAbasi Okon, Kubiat Edeheudim George

Journal of Advances in Medicine and Medical Research, Page 72-83
DOI: 10.9734/jammr/2021/v33i2131135

Aims: Eating of fruits prevent several diseases in man but unhealthy ripening methods are reported in many countries. This study aimed at determining the various fruit ripening methods and knowledge of the health effects associated with the use of calcium carbide as an artificial ripening agent by fruit sellers.

Study Design: A descriptive cross sectional design was used.

Place and Duration of Study: The study was carried out in the 3 major markets in Uyo capital city territory, Akwa Ibom State, Nigeria between April and June, 2021.

Methodology: One hundred and ninety nine fruit sellers [19 (9.5%) men, 180 (90.5%) women] between the ages of 18-67 years were recruited through systematic random sampling. Data on methods of fruit ripening known, ever used and mainly used and knowledge of adverse health effects of use of calcium carbide as fruit ripening agent were collected using a semi-structured questionnaire and analyzed with STATA at a level of statistical significance of P<0.05.

Results: Common fruit ripening methods known were natural ripening199 (100%), packaging in polyethylene bags 178 (89.5%) and use of calcium carbide 155 (77.9%). Main methods currently used to ripen fruits were natural ripening 125 (62.8%), packaging in polyethylene bags 45(22.6%) and use of calcium carbide 8(4.0%). Fifty four (27.1%) and 43(21.6%) knew that use of calcium carbide for fruit ripening is associated with cough and chest tightness in traders and cancers in consumers respectively. Poor knowledge of adverse health effect of use of calcium carbide in ripening fruits was reported in 147(73.9%) respondents. No significant association between socio-demographic characteristics of respondents and knowledge of use of calcium carbide in fruit ripening was observed (P>0.05)

 Conclusion: Use of unhealthy methods of fruit ripening and poor knowledge of health effects of use of calcium carbide in ripening fruits was observed. Intense education of traders on healthy methods of fruit ripening is needed.

Open Access Original Research Article

The Effect of Methyl Dopa, Nifedipine and Labetalol Treatment on Uterine, Umbilical and Fetal Middle Cerebral Artery Blood Flows in Cases Suffered from Pregnancy Induced Hypertension

Menna Allah Kamal Hassan, Mohamed Mohsen Elnamory, Ayman Abd Elaziz Eldorf, Hesham Mohamed Eltokhy

Journal of Advances in Medicine and Medical Research, Page 84-94
DOI: 10.9734/jammr/2021/v33i2131136

Background: Treatment of severe maternal hypertension is strongly indicated for the prevention of maternal complications, such as cerebrovascular accidents and placental abruption, for avoiding extreme pre maturity. The selection criteria for the various antihypertensive drugs are somewhat unclear, and although vasodilator agents reducing peripheral vascular resistance (e.g., methyldopa, nifidipine and labetalol) have been accepted for general obstetric use. The aim of the study is to compare the effect of methyl dopa, nifedipine and labetalol treatment on the doppler indices of uterine, umbilical and fetal middle cerebral artery blood flows in cases suffered from pregnancy induced hypertension.

Methods: This prospective randomized comparative clinical trial study was carried out on 75 pregnant women suffered from pregnancy-induced hypertension. The patients were divided into three equal groups: Group I: received alpha methyldopa750 mg-2000 mg per day, Group II: received labetalol 100 mg twice per day and Group III: received nifedipine oral sustained tablets 20-120mg per day.

Results: Follow up of the patients was done with assessment of the outcome measures and statistical analysis was done and revealed that the use of alpha methyldopa, nifedipine and labatalol in pregnancy induced hypertension cases produce significant reduction of blood pressure ,prolong pregnancy duration, decrease the need for maternal admission to the ICU due to uncontrolled severe hypertension, decrease insignificantly the progression of mild preeclampsia to severe preeclampsia without producing negative effect on the mother or the fetus because these drugs did not impair the uteroplacental or middle cerebral blood flow  documented by Doppler studies.

Conclusions: Use of methyl dopa, nifidipine and labetalol treatment in PIH cases make an improvement of uteroplacental and middle cerebral blood flow which indicated by maternal uterine, umbilical and fetal middle cerebral arteries doppler indices (resistive index, pulatility index and S/D ratio). Labetalol is ideal first line of treatment because it has potent and fast hypotensive effect without producing significant side effects on the mother or fetus.

Open Access Original Research Article

Comparative Study of the Effects of Lactoferrin versus Oral Iron Therapy in Obese Children and Adolescents with Iron Deficiency Anemia

Manal Mahmoud Atia, Rasha Mohamed Gama, Mohamed Attia Saad, Mohammed Amr Hamam

Journal of Advances in Medicine and Medical Research, Page 104-114
DOI: 10.9734/jammr/2021/v33i2131138

Greater prevalence of iron deficiency (ID) has been observed in overweight and obese children and adolescents. Hepcidin acts as a key regulator of iron metabolism. Hepcidin synthesis increases in response inflammatory cytokines especially Interleukin-6 (IL-6). Considering that obesity represents a low grade chronic inflammatory state, a high concentration of hepcidin has been found in obese children. Elevated hepcidin level in obese children is associated with diminished response to oral iron therapy. Lactoferrin is an iron-binding multifunctional glycoprotein and has strong capacity to modulate the inflammatory response by its capacity to reduce pro-inflammatory cytokine expression in vivo, including IL-6 and hepcidin.

Aim of the Work: To compare the efficacy of lactoferrin versus oral iron therapy in treatment of obese children and adolescents with iron deficiency anemia and the effect of therapy on serum hepcidin and interleukin 6 levels.

Methodology: This prospective randomized clinical trial was conducted on 40 obese children and adolescents aged between 6 –18 years suffering from iron deficiency anemia (IDA). They were equally randomized into one of 2 groups. Group A received regular oral lactoferrin in a dose of 100 mg/day. Group B received regular oral iron supplementation (Ferric hydroxide polymaltose) in a dose of 6 mg elemental iron/kg /day.Baseline investigations included complete blood count (CBC), iron profile (Serum ferritin, serum iron, total iron binding capacity (TIBC), transferrin saturation), serum Interleukin 6, and serum hepcidin. Reevaluation of CBC was done monthly while iron status parameters, serum IL-6 and serum hepcidin were reevaluated after 3 months of receiving regular therapy.

Results: Significant elevations in hemoglobin, MCV, MCH, Serum ferritin, serum iron and transferrin saturation with lactoferrin therapy compared to oral iron therapy. Significantly Lower TIBC after 3 months of lactoferrin therapy while the decrease in TIBC was insignificant in the iron therapy group.Lower serum hepcidin and IL6 after 3 months of lactoferrin therapy with no significant change in serum hepcidin and IL6 after iron therapy.

Conclusion: This study clearly demonstrated the superiority of lactoferrin over iron use as oral in the treatment of iron deficiency anemia in obese children not only for the better response of hematological and iron status parameters and less gastrointestinal side effects but also for its effect on decreasing inflammatory biomarkers as hepcidin and IL6.

Open Access Original Research Article

Comparative Study of Spino-pelvic Parameters between Scoliotic versus Non-scoliotic Patients with Multi-level Degenerative Lumbar Spondylosis

Mohamed Fathy Amer Mohamed, Sherif El-Sayed El-Daw, Ahmed El-Sayed El-Tantawy, Mohammed Shafik Saeid

Journal of Advances in Medicine and Medical Research, Page 124-133
DOI: 10.9734/jammr/2021/v33i2131140

Degenerative lumbar scoliosis is a multi-planner deformity seen in the aging spine. Important parameters in the evaluation of balance of the degenerative lumbar scoliosis include spino-pelvic parameters such as the LL, SS, PI, and PT besides the coronal Cobb´s angle. In order to minimize the energy associated with maintaining upright posture, sagittal balance is necessary. Significant sagittal abnormality or imbalance is commonly related to poor functional scores across multiple domains.

Aim: The aim of this study was to investigate the role of the spino-pelvic parameters in the development of scoliosis in multi-level degenerative lumber spondylosis disease.

Patients and Methods: This cross-sectional study was carried out in Tanta University Hospitals. It included the first 100 patients who visited the outpatient orthopedic department clinic from April 2019.

Results: There was a statistically significant (p ≤ 0.05) increase in each of the PI, PT and cobb´s angle and a significant decrease in SS in multi-level DLS with scoliosis patients in correlation to multi-level DLS without scoliosis patients. There were no significant differences between LL in both studied groups.

Regarding the age, sex, BMI and occupation in the two studied groups, there were no statistically significant differences. There was a significant correlation between the sex and PT in patients with multi-level DLS without scoliosis, but there was no significant correlation between sex and other parameters in both groups. There wasn´t significant correlation between the two groups by increasing the age. Manual workers in scoliotic group show higher PT and smaller SS than in non-scoliotic group, which give a significant correlation between the occupation and these spino-pelvic parameters.

Conclusion: Importance of a thorough discussion of the risks of deformity progression weighed against the anticipated benefits with patient’s during clinical consultation return to the spino-pelvic parameters. Measurement of these spino-pelvic parameters can help in monitoring progression of disease in patients and allow physicians to provide better prevention, treatment and control.

Open Access Original Research Article

Factors Affecting Quality of Anticoagulation Achieved with Warfarin as Thromboprophylaxis for Stroke Prevention in Non-valvular Atrial Fibrillation

Shabeer Ahmad Paul, Gouranga Prasad Mondal, Ramesh Bhattacharyya, Kartik Chandra Ghosh, Sarbajit Das, Hema Krishna, Chandrakanta Patra, Devlina Roy, Jyoti kiran

Journal of Advances in Medicine and Medical Research, Page 134-141
DOI: 10.9734/jammr/2021/v33i2131141

Background: Atrial fibrillation is one of the common indications of oral anticoagulation. Warfarin continues to be the most commonly used oral anticoagulant, particularly in developing countries. However, its use is limited by many factors, the most important of which is monitoring its therapeutic effect.

Objective: The objective of our study was to assess the anticoagulation quality in patients with atrial fibrillation receiving warfarin for thromboprophylaxis and the impact of various factors on the anticoagulation quality.

Materials and Methods: A total of 79 cases with non-valvular atrial fibrillation with or without a history of ischemic stroke attending the neurology clinic from September 2019 to March 2020 were studied. INR readings were taken from the outpatient record register which was converted to TTR (Time in Therapeutic Range) using the Rosendaal method. Cases that had received warfarin for less than 1 year were excluded. TTR value > 70% was considered as good anticoagulation control, TTR 60-70% as intermediate control and TTR < 60% as poor control.

Statistical Analysis: Descriptive statistics and Pearson chi-square analysis using SPSS-20.

Results and Conclusion: The mean TTR in our study was 59.72. Only 21.5% of cases in our study achieved a good anticoagulation control (TTR > 70%) while as 55.69% had a poor anticoagulation control (TTR < 60%). Males were reported to have a higher mean TTR value as compared to females (64.24 vs 55.54). High CHA2DS2VASc score and HAS-BLED score proved to have a strong predictive value for TTR less than 60. Individually, alcoholism, diabetes mellitus, hypertension and chronic kidney disease were found to be predictors of poor anticoagulation control i,e. TTR < 60. The presence of Transient ischemic attack or ischemic stroke was found to have a positive correlation with TTR > 70. A high number of adverse events (thromboembolic and bleeding) were reported in patients with TTR less than 60. The observations reflect the poor quality of anticoagulation in non-valvular atrial fibrillation patients on warfarin in the studied population.

Open Access Original Research Article

Virtual Health Care in India in the Era of COVID-19 Pandemic

Mayushi Gupta, Rohit Raina

Journal of Advances in Medicine and Medical Research, Page 142-147
DOI: 10.9734/jammr/2021/v33i2131142

Aims and Objectives: To know the role of telemedicine in fighting the pandemic situation of Covid-19 in India and facing the double burden of diseases (Communicable and non-communicable).

Material and Methods: Maintaining the norms of social distancing, we have tried to collect secondary data from different sources which will help us know how physicians and              patients' consultations are being done in this pandemic situation through teleconsultation or telemedicine.

Results: According to Bain and Company’s India Venture Report 2020, healthcare investments saw a rise in 2019 across wellness and health platforms, e-pharma, and even some telemedicine-focused players. Telemedicine space in India has gone up by almost 40 percent in 2019 – $178.4 million across 16 deals.Advancements in technology have enabled doctors from urban India to treat patients in rural areas remotely through video-call consultations. In addition,services like self-monitoring devices, disease screening solutions, and healthcare management solutions can be provided for newer threats like the recent novel coronavirus where video-call consultations aren’t enough.

Conclusion: The entire healthcare system is under attack by the novel COVID-19 virus that has no proven treatment. Hospitals are being stretched beyond their capacity and healthcare workers are falling ill. Telehealth providers, enablers, and suppliers represent a tangible resource that can remove certain patients from the hospital setting by evaluating them remotely, tracking their progress, and helping all stakeholders remain in contact as the intensive efforts for a vaccine and effective treatment are underway. Telehealth is inappropriate for all COVID-19 patients, but some patients could be examined, treated, and followed up using a mix of virtual visits, remote patient monitoring (RPM) devices, and mobile health services, apps, and wearable devices.

Open Access Original Research Article

Comparison of Changes in Corneal Biomechanical Properties before and After Photorefractive Keratectomy and Small Incision Lenticule Extraction

Amal Shaban Mohamed Mokhtar, El Sayed Abbas Nassar, Ahmed Mohamed Ghonem, Khaled Ahmed Nagy

Journal of Advances in Medicine and Medical Research, Page 148-155
DOI: 10.9734/jammr/2021/v33i2131143

Background: Corneal biomechanics is the study of the mechanical properties and responses of the cornea to external forces. Two devices are currently available for characterizing the corneal biomechanical properties in a clinical setting; Ocular Response Analyzer (ORA) (Reichert, Buffalo, New York, USA) based on bidirectional applanation tonometry and Corvis -ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) based on corneal deformation estimation using Scheimpflug imaging. Ocular response analyzer was used to assess corneal hysteresis (CH) and corneal resistance factor (CRF) to characterize changes in corneal biomechanics.

The other device is Corvis –ST which produces air pulse on the cornea then measures and records the movements using a high-speed Scheimpflug video camera in real time. It is highly sensitive and specific to differentiate healthy cornea from keratoconic one.

Aim: The aim of our study is to compare the changes in corneal biomechanical properties before and after PRK and SMILE.

Patients and Methods: This is a prospective comparative study and included 20 patients who had undergone PRK by Allegretto wave eye-Q device & 20 patients who had undergone SMILE by Visumax Ziess device.

Results: The significant difference between two groups at 6 months after surgery considering IOPb=0.027*. Integ. Radius=0.001*. SPA1=0.003*. This difference makes Femto SMILE better than PRK procedure for more stability of the corneal biomechanics and possibly lowers the incidence of postoperative ectasia.

Conclusion: According to CORVIS-ST for corneal biomechanical evaluation, the significant difference between two groups at 6 months after surgery considering IOPb=0.027*. Integ. Radius=0.001*. SPA1=0.003*. This difference makes SMILE better than PRK procedure for more stability of the corneal biomechanics and possibly lowers the incidence of postoperative ectasia.

Open Access Original Research Article

Effect of Ganoderma lucidum, Astaxanthin, Liv.52 HB and STC30 on Renal Function Parameters of Animal Models with CCL4 Induced Hepatocellular Carcinoma

G. I. Ekpo, J. T. Johnson

Journal of Advances in Medicine and Medical Research, Page 175-182
DOI: 10.9734/jammr/2021/v33i2131146

Kidneys are vital organ involved in the elimination of waste and toxins from the body and maintenance of homeostasis among other functions. Following the entrance of pathogen or xenobiotics into the body, the immune system respond and in most instances, this responses are out of proportion due to release of pro-inflamatory cytokines and the hyper response of the immune system may end up attacking certain organs of the body and hence, altering the physio-biochemical role of such organ. This study investigated the effect of some natural products commonly used in the management of hepatitis and it associated biochemical alterations on other key systems of the body. Albino Wistar rats weighing 60 to 120g were used for this study. The animals were divided into seven (7) groups of five (5) animals each. Group 1 served as the normal control and were not induced while animal in group 2 to 7 were all induced for Hepatocellular carcinoma using CCl4. Group 2 served as positive control and where not treated while animals in group 3 to 7 received various forms of naturopathic remedy as treatment; Ganoderma lucidium, Astaxanthin, Liv 52 Hb, STC30 and combination of all the remedies respectively. The treatment lasted for a period of three weeks (21 days). Twelve (12) hours after last treatment, the animals where sacrifice under chloroform anesthesia and blood samples collected via cardiac puncture. The blood samples were centrifuge at 4000rpm for 10 minutes to obtain the serum. The serum was separated and used for the estimation of serum electrolytes, urea and creatinine to examine the renal functions. Results of the investigation showed that; the serum urea concentration in group III (6.64±0.27), V (3.88±0.15), VI (3.66±0.12) and VII (3.80±0.22) where significantly (p≤0.05) decreased compared to group II (7.16±0.18) the positive control. Similar trend was also observed for serum creatinine. Serum electrolytes concentration; Na+,  K+, Cl- and HCO3- recorded  slight varying degrees of changes across all treated groups at p≤0.05 compares to the positive and normal control. From our results, HCC induced animals treated with Ganoderma lucidium, STC30, Liv 52 Hb and combined treatment showed varying degree of renal function improvement by improving glomerular filtration rate (GFR). The reduction in GFR can be observed in the positive control group as presented by it many abnormal renal parameters’ values which is indicative of renal failure and poor GFR. Administration of these natural products however, caused an observed initiation of renormalization in the values of some of the renal parameters with most of the treated groups having values that are significantly different from those of the positive control group at p≤0.05 which was not treated after induction of HCC. It may thus be concluded that the treatments used had positive effects on the Glomerular filtration rate which led to improve values of some of the renal parameters in the groups treated with these natural products.

Open Access Original Research Article

Violence Tendency among Secondary School Students: The Effect of Self-Esteem and Empathic Tendency

Mahmut Kilic, Tugba Uzuncakmak

Journal of Advances in Medicine and Medical Research, Page 195-205
DOI: 10.9734/jammr/2021/v33i2131148

Aims: Personal, familial and environmental factors can be effective in tendency to violence. This study was conducted to determine the effects of self-esteem of adolescents and empathic tendency on levels of violence tendency to secondary school students, regardless of socio-demographic characteristics.

Study Design: This study is a retrospective record study.

Place and Duration of Study: Secondary schools in the city center of Yozgat in the 2017-2018 academic years.

Methodology: In the study, the data in the records of secondary school students (n=987, boys 503, girls 484; grade range 5-8) which were collected using the scales were used. The data were analysed by correlation, independent t-test, Anova and linear regression (LR).

Results: The mean violence tendency, self-esteem, and empathic tendency scales’ scores of the students were 33.4, 69.0 and 2.4, respectively. According to the multivariate analysis, low empathic tendency, family perception of low performance, disliking school, increased TV viewing time, low self-esteem, increased age, being exposed to violence at home and not preparing for high school entrance exam were found to be statistically significant as the factors affecting the tendency to violence in order of priorities.

Conclusion: Early adolescents have a moderate level of tendency to violence. Moreover, low self-esteem, low empathic tendency, individual characteristics and parental attitudes are associated with tendency to violence.

Open Access Original Research Article

Evaluation of the Anti-Candida Activities of Some Plant Extracts on Candida tropicalis and Candida Spp Isolated from Prison Inmates in Owerri, Imo State, Nigeria

M. O. Echeta, C. A. Oyeka, C. N. Nwofor, N. E. Onyenwe, M. C. Korie, I. M. Izundu, M. O. Nzeagwu

Journal of Advances in Medicine and Medical Research, Page 206-212
DOI: 10.9734/jammr/2021/v33i2131149

Aim: This study aimed at determining the anti-candida activities of Alternanthera braziliana and Curcuma longa on Candida tropicalis and Candida spp isolated from prison inmates in Owerri, Southeast, Nigeria.

Study Design: Cross-sectional descriptive study.

Place and Duration of Study: Owerri federal prison between March 2020 - June 2021.

Methodology: The anti-candida activities of methanolic extracts of Alternanthera braziliana and Curcuma longa on Candida tropicalis and Candida spp were evaluated by the disc diffusion method. The plant extracts were obtained by soxhlet extraction using methanol as solvent. The results were obtained by measuring the inhibition zone diameter in millimeters.

Results: In order to ascertain the anti-candida activities of Alternanthera braziliana  and Curcuma longa in Owerri, Imo State, Nigeria, the antimicrobial properties of their extracts were tested by disc diffusion. Of the two plant extracts used methanolic extracts of Curcuma longa had better anti-candida properties than Alternanthera braziliana inhibiting the growth of Candida spp at the concentrations of 200 mg/ml, 100 mg/ml  and 50 mg/ml with inhibition zones ranging from 11 mm, 10 mm and 9 mm respectively. Methanolic extracts of Alternanthera brasiliana exhibited no anti-candida activity at different concentrations.

Conclusion:The results show that Curcuma longa had better anti-candida activity against Candida spp. and might be promising, at least, in the treatment of Candida spp  infections.

Open Access Original Research Article

Knowledge and Level of Diabetes Mellitus Management Compliance among Clinic Attendees at Jericho Specialist Hospital, Ibadan, Nigeria

Bolatito T. Olonisakin, Rose E. Ilesanmi, Philip A. Ojo, Christiana A. Oluwamotemi, Ademola L. Adelekan

Journal of Advances in Medicine and Medical Research, Page 222-232
DOI: 10.9734/jammr/2021/v33i2131151

Background: Diabetes Mellitus has emerged as one of the most challenging public health problems in the 21st century, it is a serious public health problem that threatens the quality of life of patients which can lead to acute and chronic complications. This study, therefore, assessed knowledge and level of diabetes management compliance among clinic attendees at Jericho specialist hospital, Ibadan, Nigeria

Methods: A descriptive cross-sectional study that employed a two-stage sampling technique was designed to fill this gap. The records revealed that the ratio of males to females was 1:3, the respondents were stratified by gender, so the proportion of females and males selected was based on the aforementioned ratios.  Systematic random sampling was then used in selecting respondents who chose to participate in the study using the list of males and females in the hospital register who was at the clinic on the day of the interview as sampling frames. A pre-tested semi-structured questionnaire was used to obtain information on two hundred and twenty respondents. Knowledge scores of ≤7, >7 was rated poor and good respectively. Data were analyzed using descriptive and inferential statistics.

Results: The mean age was 49.7±10.29 years which many (72.2%) were female. Almost all the respondents (98.2%) had good knowledge of compliance with the management of diabetes. Many (74.1%) ascertained that they sometimes forget to take their diabetes drugs. Meanwhile, most (82.5%) reported that taking medication every day is a real inconvenience for some people as they could get annoyed about sticking to their blood glucose treatment plan.

Conclusion: There was generally good knowledge on the compliance to diabetes management which there is a need to consider the certain sociodemographic factors of the patients before recommending management.

Open Access Review Article

History and Challenges Ahead for General Surgery Training in East Africa

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 39-45
DOI: 10.9734/jammr/2021/v33i2131132

This review highlights the history of the commencement of training in East Africa. The challenges faced in setting up a recognised training curriculum in General Surgery are outlined. The supply of health professionals with surgical skills is disproportionate to the world burden of surgical disease. The disproportion between the burden of surgical disease and the low numbers of trained personnel is more pronounced in developing low income countries. General surgery is being left in referral hospitals with few staff as surgical subspecialisation is gaining momentum. The provision of essential general surgery management is therefore below par which is the responsibility of the General Surgeon. In order to bridge the discrepancy training of more general surgeons is required. Specialist surgeons should also be trained first as general surgeons as it will give them the ability to respond to a general surgical emergency when practising as specialists and will provide them with a good overall understanding of the needs in general surgery.

Open Access Review Article

Relationship between Obesity-Related Hypertension: A Narrative Review

Behdad Dehbandi, Hafiz Fahad Ullah Saeed, Muhammad Furqan, Ubaid Khan, Muhammad Farhan Akhtar, Hafiz Muhammad Waqas Siddque

Journal of Advances in Medicine and Medical Research, Page 213-221
DOI: 10.9734/jammr/2021/v33i2131150

The main cause of obesity is an imbalance in consumption and caloric intake. Obesity is described as an excessive and abnormal accumulation of more than 20 percent of body fat in an individual's average body weight. The average body weight refers to an “individual's maximum healthy weight,” which is determined primarily by their height, age, and muscular growth. Obesity, however, is diagnosed by calculating the BMI which is a measure of individual’s body weight and height.  Additionally, according to the National Institutes of Health, a person with a maximum limit of BMI of 30 kg/m2 is declared obese. Moreover, despite World Health Organization concerns, the prevalence of obesity is increasing among children and adults worldwide. Excessive overweight continues to the most underestimated public health problems on a global scale, including the fact that obesity is linked with an increased risk of sickness, disability, and death.  Cardiovascular disorders, especially diabetes and hypertension have become a leading cause of death globally and these are the primary illnesses linked with obesity. However, the mechanisms behind obesity-related hypertension and other metabolic disorders remain little understood. In this present review, we discussed the correlation between cardiovascular disease and obesity, focusing on the biological processes underlying the relationship between hypertension and obesity.

Open Access Review Article

Mechanisms Causing Aging, Current Knowledge and the Way Forward

Gabriel Pisani, Byron Baron

Journal of Advances in Medicine and Medical Research, Page 233-250
DOI: 10.9734/jammr/2021/v33i2131152

The rapid advancement in research technologies and bioinformatics over the past few decades has enabled researchers to shed light on the underlying mechanisms behind aging. Whilst the progress in understanding the biochemical processes involved is impressive, a lot more still needs to be uncovered before any potential effective anti-aging treatment can be produced. Unravelling the various root causes of aging is still the most important obstacle to overcome. The data available highlights that the most likely drivers of aging are the proteosome, the ribosome and telomeres. This review focuses largely on these factors and how they contribute to initiating aging and their targeting in potential therapy against the multitude of age-associated disorders. The investigation thus far of these causative factors will be presented. Understanding these root causes and how they cause aging is fundamental to present a way forward, such that the biochemical basis of aging can be discovered, in order to usher in a new wave of therapeutics against complex diseases.