Open Access Case Report

Foreign Body in the Anterior Chamber Presenting as Inflammatory Mass on the Iris

Rajgopal Arvinth, Mimiwati Zahari, Sagili Chandrasekhara Reddy

Journal of Advances in Medicine and Medical Research, Page 19-25
DOI: 10.9734/jammr/2021/v33i2331181

A 40-year- old male factory worker presented to our eye clinic with left eye pain, redness and blurring of vision, associated with history of an injury sustained while hammering a nail into the wall               three days ago.  He had mild symptoms at the onset of the injury.  Slit lamp examination of left eye showed a small, self-sealed laceration corneal wound at the temporal limbus and a smooth, well      defined, oval mass on the iris in the anterior chamber in the lower temporal quadrant. Rest of the anterior segment and fundus were normal. X-ray orbits showed no intraocular foreign body in the             left eye.  In view of clinical suspicion, we proceeded with a CT scan of orbits which showed the presence of a small metallic foreign body in the anterior chamber of left eye. After giving topical antibiotic, cycloplegic, and corticosteroid eye drops along with systemic antibiotics for three days, we planned surgical removal of the mass in the anterior chamber. After the mass was removed, we noted a small metallic foreign body embedded within the fibrin mass. The same treatment was continued postoperatively. The left eye became white and quiet, and vision improved to 6/6 with above treatment. The key learning point presented is that when the history is suggestive of intraocular foreign body, even though the X-ray orbits does not show the foreign body one has to get CT scan of orbits done to rule out its presence, especially when there is inflammatory mass in the anterior chamber as seen in our case.

Open Access Case Study

Presentation of Small Bowel Volvulus in East Africa

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 251-256
DOI: 10.9734/jammr/2021/v33i2331208

Introduction: A benign gastrointestinal surgical condition involving torsion of part or all of a segment of small bowel on its mesenteric axis is small bowel volvulus (SBV). The clinical presentation is similar to acute mesenteric ischaemia and hence a preoperative clinical diagnosis is difficult to obtain. In developing countries, as a presenting surgical cause of small bowel obstruction it has contributed to a significant burden. The aim of this case report was to discuss a typical case of small bowel volvulus in a developing country and highlight the importance of resuscitation and early surgical intervention.

Presentation of case: A 35 year old lady admitted to hospital with a 3 day history of colicky central abdominal pain. She reported a long period of fasting and sudden ingestion of food. On physical examination her abdomen was moderately distended with minimal tenderness. Laboratory investigations were normal and a plain abdominal X-ray revealed features suggestive of small bowel obstruction. After resuscitation the patient was taken for a laparotomy where evidence of SBV was found. An omental band adhesion was divided, the volvulus untwisted and the small bowel was all viable. The patient made an uneventful postoperative recovery.

Discussion: The incidence of SBV is higher in Africa, Asia and the Middle East compared to the Western world. Secondary SBV is more commonly found in older age groups however primary SBV is more common in children. The most common complaints of SBV includes abdominal pain, abdominal distention and vomiting. The mortality rate due to SBV has been found to be decreasing with early diagnosis due to abdominal CT scanning. This reduction in mortality is due to a reduction in the incidence of gangrene of the SBV.

Conclusions: Due to the high mortality and variable presentation, surgeons must consider small bowel volvulus a probably diagnosis in a patient with abdominal pain and features of small bowel obstruction. Early surgical intervention is necessary to reduce the morbidity and mortality from SBV.

Open Access Study Protocol

The Effect of Vaping and Nicotine-containing Liquids to Suppress the Immune System: A Pilot Study

Sanjana Anand, Madeline Wilkerson, Robert Malkin

Journal of Advances in Medicine and Medical Research, Page 284-291
DOI: 10.9734/jammr/2021/v33i2331212

Aims: We present a pilot study to illustrate how the impact of vaping can be quickly and conclusively documented in a large population and appropriate subpopulations.

Methods: It has been predicted that with longer duration and higher frequency of vaping, there would be a higher frequency of, a longer duration of, and more severe flu and cold symptoms — indicating a negative impact on the immune system. Studies have linked electronic cigarettes and vaping to respiratory and cardiovascular issues, drastic changes in blood pressure, and the reduced function of tissues and cells in the lungs, but only in small populations, making generalization to the entire population less convincing. A sample of 120, 18–22-year-olds in northern California were asked to complete a 14-question, two-minute, anonymous survey. Those with pre-existing respiratory ailments or a family history of respiratory ailments were excluded from the study along with those who smoke cigarettes or have smoked cigarettes in the past. The survey collected the frequency and time spent vaping and the severity, frequency, and longevity of the flu and cold symptoms. Responses were converted into numerical values and analyzed.

Results: Those who vaped more often had more severe flu and cold symptoms (p<0.005). However, no strong trends were present as can be expected from a pilot study. A power analysis based on this pilot data suggests that only 667 subjects would be required to answer the short survey to reach statistical significance.

Conclusion: A quick survey was created to show the negative effects of vaping on a general population. Showing effects generalizable to the entire population would require a very reasonably sized sample and could easily allow analysis of subpopulations.

Open Access Opinion Article

A Nudge to Physicians to Achieve LDL Goals

Reagan F. Cabahug

Journal of Advances in Medicine and Medical Research, Page 122-127
DOI: 10.9734/jammr/2021/v33i2331193

Reduction in coronary events rates in high-risk patients is feasible by altering cardiovascular risk factors. In the US and most European Countries, the leading cause of death is coronary heart disease (CHD). Hypercholesterolemia is the principal risk factor for coronary artery disease. High-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) are significant risk factors for CHD [1]. Hydroxymethylglutaryl-CoA (HMG-Co-A) inhibitors are the most effective treatment of cutting LDL-C levels with a subsequent reduction in cardiovascular death and morbidity. A nudge happens when a choice architecture is planned to control behaviour predictably without curbing an individual’s choice [2]. For a nudge to be influential, the direction and force should be in line with professional standards. The article detailed how patients' and physicians' actions contributed to the increasing incidence of cardiovascular diseases. Nudges either digital or  manual (use of post-it) can be useful in influencing physicians to be proactive and can increase patients’ adherence to the therapy. Trust between the patient and the physician is crucial in attaining these goals. Nudges can be a valuable management tool for steering correct behaviours among healthcare providers. The technique is to ensure that physicians see them as something constructive and not irritating or controlling noodges.

Open Access Original Research Article

Relation between Fetal Renal Artery Doppler ‎Indices and Non-PROM Oligohydramnios in ‎Third Trimester of Pregnancy

Asmaa Ibrahim Laag, Nareman Mahmoud Elhamamy, Amr‏ ‏Mohamed Tawfek Elbadry, Atef Hammad Teama

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2021/v33i2331179

Background: Amniotic fluid is the liquid which surround the fetus after the first few weeks of gestation. Amniotic fluid is derived mostly from the fetus and has many functions that are essential for normal growth and development. The aim of this work is to study the relation between fetal renal artery flow velocity waveforms and amniotic fluid volume in normal pregnancies and those complicated by oligohydramnios.

Methods: This prospective observational study was carried out on 40pregnant women (10) of them were with normal amount of amniotic fluid (group I), while (30) of them suffered from oligohydramnios (group II).By using color doppler ultrasound imaging, the fetal renal circulation can be assessed. Intermittent assessment of renal artery flow velocity waveforms during the early stages of pregnancy may help in predicting changes in amniotic fluid dynamics.

Results: There was a non-significant difference between cases with normal amount of amniotic fluid and cases with oligohydramnios in Gestational age, Maternal age, fetal femur length, bi parietal diameter, abdominal circumference and Fetal weight. There were increased values of fetal renal artery Resistance index (RI) and Pulsatility index (PI) in cases of oligohydramnios than cases with normal amount of amniotic fluid. There was no correlation between Peak systolic velocity (PSV) and Amniotic fluid index (AFI). There was a significant difference in End diastolic velocity (EDV) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Also, there was a significant difference in Systolic diastolic ratio (S/D) and Amniotic fluid index (AFI) between cases with normal amount of amniotic fluid and cases with oligohydramnios.

Conclusions: There is a relation between renal artery flow velocity waveforms and oligohydramnios using Pulsed wave Doppler Ultrasonography. There are higher values of renal artery Resistance index and Pulsatility index in cases of oligohydramnios more than cases with normal amount of amniotic fluid.

Open Access Original Research Article

Prospective Study: The Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block versus Serratus Plane Block in Patients Undergoing Modified Radical Mastectomy

Martina Farag Wahba Mekhaeil, Shaimaa Farouk Abdelkader, Hesham Mohammed Marof, Ayman Abd Elmaksod Yousef

Journal of Advances in Medicine and Medical Research, Page 9-18
DOI: 10.9734/jammr/2021/v33i2331180

Background: Breast Cancer is the most commonly occurring cancer affecting ‎women undergoing modified radical mastectomy, causing acute pain, and in ‎high percentage of patients it progresses to chronic pain syndromes. The Erector Spinae Plane Block (ESPB) ‎and Serratus Anterior Plane Block (SAPB) are options of regional anesthesia that can produce reliable ‎analgesia. In this study we aimed to evaluate the analgesic efficacy of ‎ultrasound guided ESPB and SAPB in patients underwent modified radical ‎mastectomy operation.

Patients and Methods: Patients were randomly classified using computer generated numbers ‎concealed in ‎ sealed opaque envelopes into three equal groups; 30 patients ‎were enrolled in each group. ‎Group I: Control Group (C): Patients received intravenous (IV) systemic analgesia only, Group II: ESPB group: Patients received ‎ipsilateral ultrasound guided ESPB using 20 ml bupivacaine 0.25% at the ‎level of the 4th thoracic segment (T4). and Group III: SPB group: Patients received ipsilateral ‎serratus plane block using 30 ml bupivacaine 0.25% at the level of the 5th rib.‎

Results: In this study, 113 patients were assessed for eligibility, 16 patients ‎did not meet the criteria and 7 patients refused to participate in the study. ‎The remaining 90 patients were randomly allocated into three groups (30 ‎patients in each). All patients (90) were followed-up and analyzed ‎statistically‎.

Conclusion: Ultrasound-guided SAPB and ESPB provided effective post-‎operative analgesia in patients undergoing modified radical mastectomy with ‎lower pain scores, less peri operative analgesic consumption and longer ‎duration of analgesia in SAPB.

Open Access Original Research Article

Association of Adiponutrin/Patatin Like Phospholipase 3 (PNPLA3) I148M Gene Variant with Chronic Hepatitis C in Egyptian Children

Mahmoud Mohamed Motawae, Mohiee El-Deen Abd El-Aziz Awad, Hanaa Ahmed Elaraby, Manal Abd El-Wahed Eid, Hanan Hamed Soliman, Nermine Ahmed Ehsan, Doaa Mohammed Salah El-Deen El-Sawy

Journal of Advances in Medicine and Medical Research, Page 26-42
DOI: 10.9734/jammr/2021/v33i2331182

Background: Chronic hepatitis C (CHC) represents a leading cause of liver-related mortality worldwide. The patatin-like phospholipase domain-containing 3 gene (PNPLA3/adiponutrin) rs738409 (I148M) single-nucleotide polymorphism (SNP) has been reported to be linked with the severity and progression of liver fat content and liver fibrosis in CHC among different racial groups. Such reports are lacking in CHC Egyptian children.

Aim of Study: To evaluate the possible association of PNPLA3-I148M gene variant with the severity of liver fat content and liver fibrosis in Egyptian children with CHC.

Patients and Methods: Fifty normal-weighted children (mean age 10.62±2.59 years) with CHC were subjected to genotyping of PNPLA3-I148M gene variant using the real time PCR TaqMan assay. FibroScan examination for assessment of both liver fibrosis by Fibroscan liver stiffness (LMS) and liver steatosis by the controlled attenuation parameter (CAP) scores and histological examination of liver biopsies for assessment of liver steatosis, and METAVIER scoring for necroinflammatory activity grades and liver fibrosis stages were done for all patients as well as appropriate laboratory investigations. APRI and FIB-4 indices as well as insulin resistance using HOMA-IR were also calculated.

Results: 34 cases (68%) had CC genotype (wild CC genotype) ,9 cases (18%) had CG genotype (heterozygous for the risk G allele) and 7 cases (14%) had GG genotype (homozygous for the risk G allele). Significant higher values of LSM and CAP steatosis scores were found in patients with CG and GG genotypes compared to those with CC genotype. CG gene variant and GG gene variant were significant positive predictive factors for histopathological liver steatosis and fibrosis stages and inflammatory activity grades among the studied patients. Significant higher values of many laboratory variables (AST, fasting blood glucose, fasting serum insulin, and HOMA-IR) but lower platelets count was found in patients with G allele (CG+ GG) compared to patients without G allele (CC). In addition, significant positive correlations between PNPLA3-I148M gene variant and indicators of hepatic steatosis and fibrosis and many laboratory parameters (AST, APRI, FIB4, FBS, fasting serum insulin, and HOMA-IR) but a significant negative correlation between PNPLA3-I148M gene variant and platelet cell count were found among the studied patients.

Conclusion: Data of this study suggested that polymorphisms in the PNPLA3 I148M gene variant could contribute to the severity of hepatic steatosis and fibrosis of the studied Egyptian children with CHC.

Open Access Original Research Article

Gemcitabine Plus Vinorelbine for Refractory or Relapsing Non-Hodgkin Lymphoma: Response Rate and Survival

Sally Hamdy Elsied Abd Elbary, Wael Mansour Saed, Fatma Zakaria Hussein, Ashraf fathy Barakat

Journal of Advances in Medicine and Medical Research, Page 43-53
DOI: 10.9734/jammr/2021/v33i2331184

Background: Two chemotherapeutic agents, vinorelbine and gemcitabine, have shown encouraging early results in the treatment of heavily pre-treated relapsed or refractory lymphoma when used as single agents, with responses of between 20 and 47%. This work aimed to evaluate the role of gemcitabine and vinorelbine in the treatment of relapsed and /or refractory aggressive Non-Hodgkin Lymphoma (NHL) as regard response rate, survival analysis.

Methods: This prospective study was conducted on 20 patients who had relapsed and /or refractory NHL and treated with a minimum follow of 6 months. All patients were subjected to full clinical examination, laboratory and radiological study. Vinorelbine, Gemcitabine, dexamethasone, filgrastim (VGF) was administrated, On days 1 and 8, patients received vinorelbine 25 mg/m2, Gemcitabine 1000 mg/m2 and Dexamethasone 16mg/m2 I.V, On day 9, they received peg-filgrastim 6 mg subcutaneously, Patients received 4 cycles of VGF, Assessment was performed after 4th cycle of treatment and according to response during follow up period, the patient received 2 more cycles with minimum follow up 6 months and/or PET-CT was done in all patients to evaluate response rate.

Results: Regarding status; 60 % of patients were relapsed and 40% of them were refractory. Regarding line therapy: all patients were treated with 1st line protocol of Rituxan/Rituximab-Cyclophosphamide-Hydroxydaunorubicin-Oncovin-Prednisone regimen (R-CHOP), and 4 of them had been treated with 2nd line chemotherapy of Ifosfamide, Cisplatin or Carboplatin, and Etoposide (ICE). So 80% of patients received VGF chemotherapy as 2nd line, while 20% of them received it as the 3rd line. And there was no statistical difference between relapsed and refractory groups regarding lines of VGF chemotherapy. Regarding the toxicity of VGF (toxicity criteria as defined by Chesson and WHO); 50% of patients complicated with grade III anaemia, 50% of patients complicated with grade III neutropenia, 60% of patients complicated with grade III thrombocytopenia, 20% of patients complicated with grade II GIT upset, 40% of patients complicated grade II thrombophlebitis and 40% of patients complicated with grade II neurotoxicity.

Conclusions: VGF shows substantial activity in relapsed or refractory aggressive NHL. The regimen is generally well-tolerated, but haematological toxicity is common.

Open Access Original Research Article

Impact of Placenta Previa on Fetal Growth

Hassan Abubakr Elrewany, Mohamed Mohsen El Namori, Shahinaz Hamdy Elshourbagy, Ahmed Mahmoud Awarah

Journal of Advances in Medicine and Medical Research, Page 54-63
DOI: 10.9734/jammr/2021/v33i2331186

Background: Placenta Previa refers to the presence of placental tissue that extends over the internal cervical is during pregnancy. The incidence of this condition is reported to be 2% at 20 weeks of gestation and decreases to around 4–6 per 1000 births between 34 and 39 weeks through trophotropism. The aim of the work is to evaluate fetal growth in pregnancies complicated by placenta Previa.

Methods: This cross-sectional study was done on 100 pregnant females with placenta Previa aged 18-35 years. Cases were defined as patients with gestational age 24-40 weeks, BMI 18-30 kg/m2, Singleton fetus and diagnosed having placenta Previa; confirmed by trans-vaginal ultrasound in the second and third trimester. Complete history, vital signs and complete obstetric examination, laboratory and radiological investigations (ultrasound done trans-abdominally to evaluate fetal weight, biometry and Doppler studies) were taken.

Results: The gestational age ranged from 34-39 weeks with a mean value 36.03 ± 1.23 weeks and a median value 36 weeks (IQR = 35-37 weeks). The femur length ranged from 33.14-39.14 weeks with a mean value 35.44 ± 1.56 weeks and a median value 35.14 weeks (IQR = 34-36.9 weeks).The abdominal circumference ranged from 32.86-39.14 weeks with a mean value 35.43 ± 1.65 weeks with a median value 35.14 weeks (IQR = 33.9-36.7 weeks).

As regard to umbilical (UA) and middle cerebral (MCA) arteries Doppler resistant index (RI), UA ranged from 0.48-0.58 with a mean value 0.53 ± 0.03 and a median value 0.53 (IQR = 0.51-0.55). MCA ranged from 0.75-0.85 with a mean value 0.80 ± 0.03 and a median value 0.79 (IQR = 0.77-0.82).

Conclusion: Placenta Previa led to preterm delivery (<36 weeks) in about one third of the study cases. Femur length was <36 weeks in 65 patients. Abdominal circumference was <36 weeks in 61 patients. Placenta Previa had insignificant effect on umbilical (UA) and middle cerebral arteries Doppler resistant index.

Open Access Original Research Article

Evaluation of Rehabilitation of Surgically Repaired Flexor Hand Tendons and Ultrasonographic Follow up of Their Healing

Nourhan Elsayed Hebeshi, Nagat Mohamad El-Gazzar, Amal Mohamad El-Barbary, Marwa Ahmed Abo El-Hawa

Journal of Advances in Medicine and Medical Research, Page 64-72
DOI: 10.9734/jammr/2021/v33i2331187

Objectives: To evaluate the role of early rehabilitation of surgically repaired flexor hand tendons in improvement of clinical outcome and the role of musculoskeletal ultrasound in follow up of their healing.

Patients and methods: Thirty patients with 31 repaired flexor tendons. Assessment was done after 2nd, 4th,8th and 12th weeks of rehabilitation by visual analogue scale (VAS), total active motion of injured fingers (TAM), grip strength, hand assessment tool (HAT) score and ultrasound (US).

Results: There was a significant development in pain assessed by VAS, TAM, grip strength and HAT score of the affected hand (p<0.001). Ultrasonographic assessment of healing flexor tendons showed significant improvement in defect size, thickness, vascularity, echogenicity and margination. There was positive correlation between margination of healing flexor tendon with VAS, hand grip and HAT score.

Conclusions: Application of proper rehabilitation programs has a great impact on improving the functional outcome after surgical repair of flexor hand tendons. High-frequency ultrasound is used to follow up tendon healing after surgical repair and to assess the state of tendon repair in relation to clinical result.

Open Access Original Research Article

Performance of TyrerCuzick Model for Breast Cancer Risk Assessment among Pakistan’s Females

Rufina Soomro, Rabia Niaz

Journal of Advances in Medicine and Medical Research, Page 73-79
DOI: 10.9734/jammr/2021/v33i2331188

Background: Breast cancer incidence is highest in Pakistan among Asian countries. The known risk factors are family history, hormonal exposure, benign proliferative diseases, and high mammographic density which are included in the TyrerCuzick model. The model needs validation studies to implement in prediction, screening, and prevention strategies among different populations. This study aims to validate the TyrerCuzick model for Pakistan's females.

Methods and Materials: A total of 317 biopsy-proven breast cancer patients from the breast surgery clinic at Liaquat National Hospital were included. The 10 years risk score is calculated by applying the TyrerCuzick model software. Subcategories of low risk <2%, moderate risk 2-7%, and high risk >8% were identified. Further risk group stratification is done to find the association with individual factors i.e., age group, menopausal status, family history, and mammographic density.

Results: The mean TyrerCuzick score was low to moderate i.e. 2.23±1.66. The score was distributed as low risk 174(54.9%), moderate risk 137(43.2%), and high risk 6(1.9%). Low risk was observed among 116(81.7%) of less than 50 years old, 105(78.9%) premenopausal, 113(59.8%) with no family history, and 120 patients (59.7%) with low mammographic density. Most of the moderate risk was found in 113(64.6%) of more than 50 years old, 109(60.2%) with postmenopausal, 24(61.5%) with family history, 58(50%) with high mammographic density respectively.

Conclusion: The TyrerCuzick model can predict risk for developing breast cancer among Pakistan’s femalesclose to accurate among older age, postmenopausal, family history of breast cancer, and high mammographic density.

Open Access Original Research Article

Dexmedetomidine, Ketamine and Lidocaine Infusion for Prevention of Postoperative Nausea and Vomiting in Laparoscopic Gynecological Surgery: Randomized Trial

Aya Ibrahim Moustafa, Mohamed Elsayed Afandy, Hesham Mohamed Marouf El Demairy, Hoda Alsaid Ahmed Ezz

Journal of Advances in Medicine and Medical Research, Page 101-109
DOI: 10.9734/jammr/2021/v33i2331191

Background: The intraoperative use of large bolus doses or continuous infusions of potent opioids may be associated with increased analgesic consumption postoperatively. In ambulatory surgery, opioid related side effects, such as postoperative nausea and vomiting (PONV), prolonged sedation, ileus and urinary retention may delay recovery and discharge or cause unanticipated hospital readmission. The aim was to evaluate the effect of opioid sparing technique via infusion of dexmedetomidine, ketamine and lidocaine on post-operative nausea and vomiting in laparoscopic gynecological surgery.

Methods: A total of 80 patients were randomly allocated into 2 groups, 40 patients each. Control group (group c) received fentanyl while, Study group (group S) received infusion of a mixture of dexmedetomidine, ketamine and lidocaine. The PONV impact scale, intraoperative consumption of isoflurane and fentanyl and post operative 24 hr. morphine consumption were measured.

Results: 18 (45%) patients of control group experienced PONV versus 7 (17.5%) patients of study group and it was clinically significant. Clinically significant vomiting was observed in10 (25%) patients of control group and 1 (2.5%) patient of study group. There was a marked reduction in fentanyl, isoflurane and 24 hours’ morphine consumption in group S compared to group C. 

Conclusion: Opioid sparing anesthesia with dexmedetomidine, ketamine and lidocaine infusion are superior to fentanyl for prevention of post-operative nausea and vomiting and reduction of isoflurane and, fentanyl consumption and provides better patient satisfaction in laparoscopic gynecological surgery.

Open Access Original Research Article

Analysis of Fatality of Cases by the New Coronavirus, in the Mexican State of Guanajuato: A Cross-sectional Study

Nicolas Padilla-Raygoza, Gilberto Flores-Vargas, Efraín Navarro-Olivos, María de Jesús Gallardo-Luna, Francisco Javier Magos-Vazquez, Daniel Alberto Diaz-Martinez

Journal of Advances in Medicine and Medical Research, Page 110-121
DOI: 10.9734/jammr/2021/v33i2331192

Aims: COVID-19 has been a big public health challenge around the world in the past several months. The aim of this study is to describe the epidemic and report of fatality of confirmed cases of COVID-19 in the Mexican state of Guanajuato, until October 2, 2020.

Study Design:  Cross-sectional, quantitative, analytical study.

Place and Duration of Study: Registries of confirmed cases for COVID-19 in Mexican population from January until October 2, 2020, from National System of Epidemiological Surveillance/ General Direction of Epidemiology/ Secretary of Health, Mexico.

Methodology: Based on the National Epidemiological Surveillance System Database from Mexico was used in this study. Data were collected on age, sex, comorbidities (i.e., diabetes, chronic obstructive pulmonary disease, asthma, hypertension, cardiovascular disease, immunosuppression, chronic kidney disease, obesity, and smoking), date of death, and real-time reverse transcription polymerase test results. Statistical analyses used were Case Fatality Ratio, Chi- squared test and P-value to show relationships among variables. Odds Ratio and confidence intervals at 95% were reported to show the effect of comorbidities on death due to COVID-19. Also, a Bayesian network model was fitted to assess the statistical dependence among risk factors, comorbidities, and death.

Results: There were 100,109 suspected cases, of which 41.69% were positive for SARS-CoV-2. Being older than 60 and male had a higher effect on fatality by COVID-19. In Guanajuato state, 1,457 (48.68%) of deaths occurred in Mexican Institute of Social Security, with a case fatality ratio of 15.63%; meanwhile, in the Ministry of Health from Guanajuato State occurred 1,260 (42.10%) of the deaths with a case fatality ratio of 4.14%. Diabetes (OR 5.16, CI95% 4.77–5.59), chronic obstructive pulmonary disease (OR 6.34, CI95% 5.37–7.49), immunosuppression (OR 2.85, CI95% 2.17–3.76), cardiovascular disease (OR 4.20, CI95% 3.51–5.02), hypertension (OR 4.74, CI95% 4.39–5.11), chronic kidney disease (OR 6.27, CI95% 5.30–7.42), obesity (OR 1.87, CI95% 1.72–2.03), and smoking (OR 1.60, CI95% 1.41–1.81) had effect on death by COVID-19. Asthma had a preventive effect on death (OR=0.72, CI95% 0.54–0.97), but this effect is diluted after adjusting by sex and age. In all cases, age and sex, acted as confounder.

Conclusion: Among the Guanajuato population with COVID-19, the main risk factor for dying were age and sex. However, diabetes, chronic obstructive pulmonary disease, immunosuppression, cardiovascular disease, chronic kidney disease, obesity, and smoking are risk factors for dying. Although, comorbidities and risk factors are highly correlated.  HIV/AIDS has no effect on fatality from SARS-CoV-2 disease and whereas asthma shows to be a protective factor.

Open Access Original Research Article

MR Imaging of Pancreatic Lesions

Mohamed Shawky Mohamed Abd Rabou, Khaled Ismail El Shafey, Rania Essam El Deen Mohamed, Rasha Mahmoud Dawoud

Journal of Advances in Medicine and Medical Research, Page 128-136
DOI: 10.9734/jammr/2021/v33i2331194

Aim: The aim of this work was to evaluate the role of MRI in differentiating between benign and malignant pancreatic lesions and its correlation with histopathological results as the reference standard.

Patients and Methods: This MRI study included 30 patients, 17 females and 13 males with a mean age 50 years. Sixteen patients had malignant masses (14 patients were adenocarcinoma, one patient was lymphoma and one patient was metastasis) and 14 patients had benign masses (7 patients were pancreatic pseudocysts, two patients were pancreatic abscesses, three patients were simple cysts and two patients were focal pancreatitis). The main clinical symptom was abdominal pain and most of masses were located in the head of the pancreas.

Results: In our study, 25 cases of the 30 patients showed increased intensity at T2-weighted images. Most of malignant cases showed low or equal intensity on T1- and high intensity on T2-weighted images compared to normal pancreatic parenchyma. In our study, DW-MRI was performed on all subjects at b-values of 500 and 1000 s/mm2. Benign pancreatic masses as pancreatic pseudocyst, simple cyst and abscess show low signal intensities on DWI, however malignant pancreatic masses as adenocarcinoma, lymphoma and metastasis show high signal intensities on DWI with a cut-off value of 1.5 x10-3 s/mm2 for the differentiation of benign from malignant pancreatic masses by b-value 1000 s/mm2 with the sensitivity, specificity, PPV, NPV& p value were 100%, 83.33%, 100%, 88.88% and <0.001 respectively.

Conclusion: MRI plays an important role in the diagnosis of different pancreatic lesions and can assess the neoplastic pancreatic lesions with accurate detection of extension, nodal involvement and hepatic metastatic lesions. It also has a major role in differentiation between benign and malignant pancreatic lesions by the aids of DWI.

Open Access Original Research Article

Expression of Salivary miRNA-31 in Oral Submucous Fibrosis

Saba Khan, Saima Akram Butt, Sobia Hassan, Rizma Khan

Journal of Advances in Medicine and Medical Research, Page 137-144
DOI: 10.9734/jammr/2021/v33i2331195

Objective: The present study aimed to evaluate the salivary miRNA31 expression in controls and cases and associate miRNA31 levels with clinical parameters of oral submucous fibrosis.

Methods: This case control study was conducted in a hospital setup. A total of 50 individuals participated in the study with 25 subjects in group I (healthy individuals) and 25 subjects in group II 25 diagnosed cases of (oral submucous fibrosis). The sample size was calculated with open Epi version 3.01.  A detailed assessment of clinical parameters of oral submucous fibrosis was made. Unstimulated saliva samples were collected from all study subjects meeting the inclusion criteria and analysis of saliva samples was done by qRTPCR.

Results: The results showed high expression levels of miRNA31 in oral submucous fibrosis as compared to the control group. The study demonstrated significantly higher median fold change of miRNA-31 expression level in OSMF patients as compared to the participants in the control group. Correlation between age of patients and miRNA31 fold change was discerned using the Spearman rank test that demonstrated a non-significant negative correlation.

Conclusion: Increased expression levels of miRNA 31 among oral submucous fibrosis as compared to the control group make it a promising salivary biomarker that detects oral submucous fibrosis at an early stage of the disease.

Open Access Original Research Article

Trans Vaginal Versus Trans Abdominal Ultrasound Guided Embryo Transfer in In vitro Fertilization and Intra Cytoplasmic Sperm Injection (IVF–ICSI)

Aya Medhat Mohamed, Ahmed Mahmoud El Khyat, Adel El Shahat El Gergawy, Ahmed El Sayed El Halwagy, Mahmoud Salah El Deen Hamouda

Journal of Advances in Medicine and Medical Research, Page 145-152
DOI: 10.9734/jammr/2021/v33i2331196

Background: Embryo transfer (ET) refers to a step in the process of assisted reproduction in which one or several embryos are placed into the uterus of a female with the intent to establish a pregnancy. This technique, which is often used in connection with in vitro fertilization (IVF), has widely been used in animals or human. The aim of this study was to compare Trans abdominal ultrasound (TAUS) with Trans vaginal ultrasound (TVUS) methods for guidance of (ET) regarding clinical pregnancy rate and patient appreciation of pain during embryo transfer.

Methods: This prospective, randomized, controlled study was conducted on 100 patients undergoing cryopreserved or fresh morula or blastocyte who were randomized (computer generated program) into 2 groups. Group I (the study group): 50 patients were subjected to embryo transfer under trans abdominal ultrasound guidance and Group II (controlled group): 50 patients were subjected to (ET) under (TAUS).

Results: There were no statistically significant differences regarding fresh and cryopreserved. TVUS group demonstrated significant reduction of duration compared to TAUS ones. Minimal pain was observed in TVUS cases compared to TAUS ones. Higher success rate and lower failure rate were demonstrated in TVUS group compared to TAUS group.

Conclusions: TVUS seems to have higher success rate with less pain sensation as well as shorter duration of the procedure in comparison with TAUS.

Open Access Original Research Article

A Five-Year Review of Caesarean Section at the Rivers State University Teaching Hospital, South-South, Nigeria

Felix Chikaike Clement Wekere, Rose Sitonma Iwo-Amah, Joseph Ngozi Kwosah, Adetomi Bademosi, Simeon Chijioke Amadi

Journal of Advances in Medicine and Medical Research, Page 159-167
DOI: 10.9734/jammr/2021/v33i2331198

Background: Caesarean section (CS) is a major obstetric surgery done for pregnant women and is lifesaving. 

Aim: The study was aimed at reviewing CS at the Rivers State University Teaching Hospital (RSUTH), to determine the prevalence, trend and indications, for improved management outcomes.

Methods: In this cross-sectional study, we reviewed five thousand, five hundred and ninety-eight (5598) cases of caesarean sections (3699 emergency, 1899 planned) managed at the RSUTH from 1st January, 2015 to 31st December, 2019.  Data collected were analysed using IBM, Statistical Product and Service Solutions (SPSS), version 25.0 Armonk, New York.

Results: There were 13,516 deliveries and 5,598 cases of CS over the review period, giving the prevalence of CS as 41.4% or 414 per 1000 deliveries.  Emergency and planned CS cases accounted for 66.1% and 33.9% respectively. An increasing trend of CS was observed over the review period. The mean age ± SD of the participants was 32.30±1.04 years (95% CI:30.26,34.34). Modal age group was 35-39 years, accounting for 33.2% followed by those aged 30-34 years (26.2%). Majority of the patients were multipara [3396 (60.7%)], married [4890 (87.4%)], Christians [5540 (99%)] and had tertiary level education [2800 (50%)]. The commonest indication for CS in RSUTH was previous caesarean section [1925(34%)], followed by cephalopelvic disproportion [757(13.4%)], foetal distress [418(7.4%)], preeclampsia [390(6.9%)] and multiple gestation [252 (4.5%)].

Conclusion: The rate of caesarean section is high in RSUTH with an increasing trend.  Although CS is lifesaving, efforts should be made to reduce the rate to the level recommended by WHO, especially in Low-middle-income countries (LMICs), where there is high aversion to CS.

Open Access Original Research Article

The Prevalence and Risk Factors of Giardia duodenalis Infection in Cats in Mexico

Camilo Romero Núñez, Laura Miranda Contreras, Rafael Heredia Cardenas

Journal of Advances in Medicine and Medical Research, Page 168-176
DOI: 10.9734/jammr/2021/v33i2331199

Aims: Giardia duodenalis is a globally distributed zoonotic protozoan. It has a variable prevalence. This study determines the prevalence of Giardia spp. in cat faecal samples from states of the Mexican Republic.

Place and Duration of Study: Was carried out in 23 of the 32 states of the Mexican Republic, from June to December 2019.

 Methodology: Stool samples from 1591 client-owned cats were analysed for the detection of G. duodenalis (cysts or trophozoites). Faecal samples were analysed by direct smear techniques with and without staining (Lugol) and centrifugal floatation (faust), and were examined under a light microscope. 

Results: Of the cats sampled, 56.94% were positive for G. duodenalis. Its prevalence was associated and is a risk factor in cats that live with other animals (Chi2= 21.84, p= 0.0001; OR= 1.61, p= 0.0001), with hunting habits (Chi2= 5.53 p= 0.01, OR= 1.27 p= 0.01), with access to the outside (Chi2= 53.06, p= 0.0001; OR= 2.13, p=0.0001) and with the aqueous faeces (Chi2= 12.30, p=0.03; Chi2= 1.71, p= 0.03). Factors for not presenting Giardia spp. in faeces were, not brushing the cat (OR=0.74, p= 0.006), provenance (OR= 0.42, p=0.02), and median height (OR= 0.78, p= 0.01). Age, gender, hair type, coexistence with other cats and other stool findings were not associated as risk factors for infection.

Conclusion: This study demonstrated a high overall prevalence of G. duodenalis in cats in Mexico, in addition to an association of its prevalence with risk factors such as cats living with other animals, hunting habits and access to outdoors.

Open Access Original Research Article

Comparative Study between Adductor Canal Block, Femoral Nerve Block and Epidural Analgesia for Management of Post-Operative Pain in Total Knee Replacement

Heba Salah Eldin Ismail Gawish, Amr Arafa Mohammed Elbadry, Nagat Sayed Mohammed El-Shmaa, Abdelraheem Mostafa Dowidar

Journal of Advances in Medicine and Medical Research, Page 177-188
DOI: 10.9734/jammr/2021/v33i2331200

Background: Total knee arthroplasty (TKA) is a common surgery that is associated with moderate to severe pain. Early ambulation and physical therapy are essential for functional recovery and long-term functional outcome after TKA as well as for reducing the immobility related complications. Hence, optimal pain relief while maintaining the motor function remains the mainstay in postoperative pain management after TKA.

Patients and Methods: This prospective randomized controlled open-labelled study was carried out at Tanta University Hospital, Orthopedic Surgery Department from January 2020 to February 2021.

Results: Heart rate was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and there was insignificant change between group I and group II.

Mean arterial blood pressure was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.NRS was significantly increased at 12 and 18 hours postoperatively in group I and II compared to group III and was insignificant change between group I and group II.

Patient satisfaction was significantly higher in group III compared to group I and group II on the second postoperative day.

Conclusion: Adductor canal nerve block provide better postoperative pain relieve with lower NRS after TKA than femoral and epidural blocks. It provides more stability of hemodynamic parameter and longer time for the 1st time of analgesic request. Also, total consumption of morphine in 1st postoperative day is lower than femoral and epidural blocks.

Open Access Original Research Article

Fetal Renal Volume and Fetal Renal Artery Doppler in Normal and Intrauterine Growth Restricted Fetuses

Samar Reyad Mostafa Al Ashmawy, Adel Alshahat Algergawy, Naglaa Lotfy Dabees, Amal El-sayed Mahfouz

Journal of Advances in Medicine and Medical Research, Page 189-199
DOI: 10.9734/jammr/2021/v33i2331201

Background: Human fetal kidney undergoes constant changes throughout the pregnancy to attain final maturity in terms of structural and functional aspect. Approximately one million nephrons are seen on either side at birth in term fetuses. Many factors both maternal and fetal affect nephrogenesis viz. maternal malnutrition, maternal hyperglycemia, Intrauterine Growth Restriction (IUGR), vitamin A deficiency, and fetal exposure to some drugs. The aim of this study was to evaluate changes in the fetal renal artery Doppler parameter and fetal kidney volume measured by 3D ultrasound system with (VOCAL) method in normally grown and growth restricted fetuses after 26 weeks of gestation.

Methods: This prospective study include 60 pregnant women  divided in to two groups, first one (A) contains 30 pregnant women with intrauterine growth restricted fetuses, and the second one (B) contains 30 pregnant women with normally grown fetuses.

Results: There was insignificant differences between two groups as regard gestational age by date but gestational age by US there was significant decrease in group A. There were insignificant differences between two groups as regard length of kidney either right or left. There was significant decrease in kidney width right and left side in group A versus group B. There was significant decrease in kidney depth right and left side in group A versus group B. There was significant decrease in kidney volume right and left side in group A versus group B. There was significant decrease in combined kidney volume in group A versus group B. There was significant increase in renal artery PI, RI in group A versus group B.

Conclusions: Fetal hypoxemia which occurs in growth restricted fetuses leads to reduction in the percentage of the cardiac output reaching the kidneys which was reflected on Doppler as increase in the renal artery pulsatility index causing reduced renal perfusion. This reduction in the renal perfusion was responsible for impaired nephrogenesis and thus decreased kidney volume in growth restricted fetuses as compared to normal fetuses.

Open Access Original Research Article

Assessment of Duration of Analgesia after Supraclavicular Brachial Plexus Block Using Bupivacaine With and Without Intravenous Dexamethasone: A Comparative Observational Study

Mohammed Muzammil, Aditya Sapra, Awadh Bihari Tiwari, H. N. Madhusudana, . Arti, Jeet Singh Arya, Meghna Majumdar

Journal of Advances in Medicine and Medical Research, Page 200-205
DOI: 10.9734/jammr/2021/v33i2331202

Aim: To compare and analyze the duration of analgesia after giving supraclavicular block using bupivacaine with and without intravenous dexamethasone.

Methodology: The study was done in a tertiary care teaching hospital over 06 months. All eligible 50 patients were divided into two groups of 25 each. Group A patients receiving block by 40 ml of 0.25% bupivacaine were compared with Group B patients receiving 40 ml of 0.25% bupivacaine along with 8 mg intravenous dexamethasone. Duration of analgesia was calculated from the time of pain relief after block to the appearance of pain or Numerical Scale Rating (NRS) more than four. Any other complications were also noted. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. As the data was found to be normally distributed bivariate analyses were performed using an independent t-test.

Results: Mean duration of analgesia was found to be significantly more among subjects given Analgesia with bupivacaine and iv dexamethasone as compared to subjects given Analgesia with bupivacaine only as p<0.05. No significant difference was seen in the distribution of complications like nausea and vomiting among the two study group when compared using Chi-square test as p>0.05.

Conclusion: In conclusion, the addition of dexamethasone supraclavicular brachial plexus block provides prolongation of the duration of the block and decreases the incidence of postoperative nausea and vomiting that may have a great impact on patient comfort.

Open Access Original Research Article

Mycology of Otomycosis in Port Harcourt

Ureh Annabel Oparaodu, Opubo Benedict da Lilly-Tariah, Kennedy Warriso

Journal of Advances in Medicine and Medical Research, Page 206-212
DOI: 10.9734/jammr/2021/v33i2331203

Tropical climate favors the growth of fungal infection in the ear resulting in otomycosis. This study is aimed at determining the predisposing factors, symptoms, prevalence and demographic data of patients diagnosed with otomycosis. This is a 1 year prospective hospital based study, between June 2017 to June 2018 at University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. Clinical features, predisposing factors and examination findings were noted on the administered questionnaire. Patients were examined and specimen collected for microscopy, culture, sensitivity and mycological studies. Our results show isolated fungi were present in 34 out of 120 ear swabs of patients and in 5 out of 120 ear swabs from the control group. The prevalence of otomycosis was 2.7%, while the ear symptom with the highest frequency was itching (86.7%) and debris in ear canal (67.6%). Patients with positive growth constitute 53% females and 47% males. Age groups 10-29 and 40-49 years had the highest and lowest number of infected patients, respectively. Candida was the commonest organism isolated accounting for 61.8% followed by Aspergillus spp. (23.5%) and Penicillium (8.8%).

Open Access Original Research Article

Effects of Structured Exercise Program on Tenderness and Cyclic Mastalgia in Obese Women: An Experimental Study

Muskan Bhojwani, Shubhangi Patil, Shruti Deshpande

Journal of Advances in Medicine and Medical Research, Page 213-219
DOI: 10.9734/jammr/2021/v33i2331204

Background: Cyclic Mastalgia affects women who are menstruating in their 20s, 30s, or 40s. This pain starts about a week before commencing menstruation. During this period, the breasts become sore, tender, and swollen, though symptoms improve later in the cycle or it may be so severe that the patients cannot wear tight fitting clothes or they becomes irritable. The discomfort usually occurs outside and upper portions of both breasts, and it may even affect underarms. Cyclical Mastalgia is a common condition associated with a higher risk of breast cancer. Mastalgia is common ailment that affects about 70% of women and has negative impact on their quality of life. Many scientists believe that the cause of cyclic mastalgia lies in a mix of hormonal activity and something in the breast that reacts to it. Mastalgia is a term used to describe women's discomfort with their breasts, although doctors usually neglect it.

Methods: Based on the inclusion and exclusion criteria, a total of 30 women will be selected for the study. A questionnaire of breast pain based on the McGill Pain Questionnaire, and a Cardiff chart, will all be employed as outcome measures. The individuals' pre-intervention scores will be collected, and they will be given an exercise routine to follow for four weeks, three times per week. The outcomes of the intervention will be measured afterwards. Our protocol will cover weeks of treatment. Reqular assessment will be carried out.

Discussion: This study was done to find out effectivness of exercise program in obese womens with breast mastalgia and tenderness.

Open Access Original Research Article

Knowledge, Attitude and Practices of the General Population towards COVID-19 Vaccinations: A Cross-sectional Study

Hira Abbasi, Fareena Khalil Ahmed, Muhammad Muzamil, Zaheer Hussain, Abhishek Lal

Journal of Advances in Medicine and Medical Research, Page 229-238
DOI: 10.9734/jammr/2021/v33i2331206

Aims: This study aims to evaluate the knowledge, attitude, and practices of the general population towards coronavirus vaccinations in Pakistan.

Study Design: A cross-sectional study.

Place and Duration of Study: Sample: Department of Dental Surgery, Altamash Institute of Dental Medicine, Pakistan, between March 2021 and June 2021.

Methodology: A cross-sectional study was carried out among 500 individuals who were above 18 years of age. A well-constructed questionnaire consisting of 4 parts (Demographics, Knowledge, Attitude, and Practices) was constructed containing informed consent and distributed online. Spearman correlation test was used to analyse knowledge, attitude, and practices towards coronavirus vaccinations.

Results: A total of 500 responses were collected from the participants. Most of the participants had adequate knowledge regarding the availability of the vaccines. About 116 (23.2%) participants had contracted the virus. The majority of 308 (61.7%) participants agreed on vaccines to be effective against the virus. Most of the 401 (80.4%) participants were willing to get themselves vaccinated when their turn comes. 265 out of 500 (53.1%) people have been vaccinated against coronavirus. The minority of people assumed a chip inside the vaccine and religious factors as reasons not to get vaccinated. Those residing in urban locations and with increasing age had better knowledge and attitudes towards vaccinations.

Conclusion: To control and contain the ongoing pandemic, vaccination against the coronavirus is a must. There is still scope in evaluating and improving the general population’s knowledge regarding the vaccination programs especially in the rural areas where resources and socioeconomic status is weaker.

Open Access Original Research Article

Serum Leptin and Earlier Stages of Nephropathy among Type 2 Diabetic Subjects in a Bangladeshi population

Sheikh Anwarul Karim, Samira Jamal, Sheikh Mahee Ridwan Raihan, Mohammad Alamgir Ahmed Chowdhury, Omar Faroque, Kazol Baron Bishwash, Liaquat Ali, Hajera Mehtab

Journal of Advances in Medicine and Medical Research, Page 239-250
DOI: 10.9734/jammr/2021/v33i2331207

Objective: To evaluate the relationship of Serum Leptin and Early Nephropathy among uncontrolled type 2 Diabetes Mellitus patients of Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrinology and Metabolism (BIRDEM), Dhaka and Endocrinology department of Sylhet MAG Osmani Medical College (SOMC) & Hospital Sylhet, Bangladesh.

Methods: This study was carried out from January 2013 to December 2015 among 100 type 2 diabetic patients from the outpatient department (OPD) BIRDEM and SOMC hospital.

Results: 16 out of 30 controls and 65 out of 100 people with diabetes have a family history of diabetes. Early retinopathy and neuropathy were observed in 45.5% and 36.5% diabetic subjects. Mean±SD of serum urea in control subjects was 28.65±6.27; in diabetic subjects was 30.21±7.67. Serum creatinine in controls was 1.12±0.24, in diabetic subjects was 1.13±0.25. Serum leptin levels in control subjects {1.65 (0.05-8.66)} was lower than diabetic counterpart {1.21 (0.11-13.3)}. Leptin levels in male controls {(1.29 (0.05-2.49)} was significantly (P 0.000) lower than the female controls {4.03 (0.05-8.66)}.

Conclusion: It was evident that there was very little or no association between serum leptin level and the indices of renal function. No changes of circulating serum Leptin concentration in the earlier stages of Diabetic Nephropathy were found.

Open Access Original Research Article

Pattern of ocular Diseases among Children under Five Years of Age in Southeast, Nigeria

Arinze Anthony Onwuegbuna, Apakama Akunne Ijeoma, Chianakwalam Emeka Akujuobi, Amobi Miriam-Benigna Chika

Journal of Advances in Medicine and Medical Research, Page 257-263
DOI: 10.9734/jammr/2021/v33i2331209

Background:  Children under 5 years are prone to ocular disorders which could be congenital or acquired. Early recognition of these conditions and timely intervention enhances optimum results. There is paucity of data on the pattern of ocular disorders among these children in Nigeria and this makes it difficult for policy makers to plan health systems that will target this very important group of the population. 

Aim: To determine the pattern of ocular diseases among children less than 5 years of age in Onitsha, Anambra state Nigeria.

Methods: This was a retrospective study of children under 5 years of age that presented to City of Refuge Specialist Eye Clinic Onitsha, Nigeria between January 1st, 2016 to December 31st, 2020. Their case files were retrieved and relevant information extracted. Sociodemographics, month of presentation to the eye clinic and diagnoses were analyzed.

Results: A total of 133 children were studied. The patients comprised 85 (63.9%) males and 48 (36.1%) females, with an approximate male to female ratio of 1.8:1. Eye diseases seen were both congenital 32(24.1%) and acquired 101 (75.9%). Of the congenital type, 20 (62.5%) were males, while 12 (37.5%) were females. Most common ocular morbidities recorded were allergic conjunctivitis 41(30.8%) and infective conjunctivitis 34(25.6%).

Conclusion: Most of the causes of ocular morbidity in this study were preventable or treatable. Therefore, early detection and management of eye diseases in children will reduce complications in later life.

Open Access Original Research Article

Assessment of Nutritional Status of Chronic Renal Failure Patients on Hemodialysis in Damanhour National Medical Institute in El-Beheira Governorate, Egypt

Kholoud Adel Khalil, Shimaa M. Saied, Salwa Abd El-Mageed Atlam, Gamalat Mohamed Ali El-Saleet

Journal of Advances in Medicine and Medical Research, Page 264-275
DOI: 10.9734/jammr/2021/v33i2331210

Background: Nutritional problems are of the most important risk factors of increasing mortality rates in chronic renal failure patients on hemodialysis and morbidity occurring from malnutrition significantly severely affects their quality of life.

Aim: To assess the nutritional status of chronic renal failure patients on hemodialysis (HD) attending HD unit in Damanhur National Medical Institute.

Methods: A cross-sectional study was carried out in the hemodialysis unit on 174 patients. Data collection was done via a specially designed questionnaire containing; socio-demographic and clinical data, anthropometric measurements, biochemical measurements, 24-hour recall list and questions for assessment of nutritional knowledge. Malnutrition inflammation score (MIS) was used for assessment of the nutritional status.

Results: 65.5% of the patients were mildly malnourished, 24.7% were moderately malnourished and only 9.8% were normal and the level of malnutrition was significantly affected by duration of renal disease and hemodialysis duration. 44.3 % of patients had poor nutritional knowledge level, and only 4% had good nutritional knowledge and the nutritional knowledge level had a significant association with level of malnutrition. 96% did not attend any nutritional health education sessions, but they were willing to attend these sessions.

Conclusions: Malnutrition was highly prevalent among the studied patients. There was a statistically significant relationship between levels of malnutrition (MN) and the level of nutritional knowledge of hemodialysis patients.

Open Access Original Research Article

The Effect of Fat Emulsion Intralipid Infusion on Reproductive Outcome for Women with Unexplained First Trimester Habitual Abortion

Eltahera M. Goda, Sherif l. Shuwaikh, Walid M. Ata Allah, Safaa K. Maray

Journal of Advances in Medicine and Medical Research, Page 276-283
DOI: 10.9734/jammr/2021/v33i2331211

Objectives: To study the effect of the use of intralipid in management of women suffering from unexplained first trimester habitual abortion.

Methods: The study was a prospective cohort study, which conducted in Tanta university Hospital; Egypt. It included 93 women with history of two or more unexplained recurrent abortion in the first trimester. They were divided into three groups: group Ι received only intralipid, group II received low molecular weight heparin (LMWH) and low dose aspirin, and group III served as controls and received only saline as placebo. The patients were followed up until continuation of pregnancy into the second trimester. Occurrence of complication and pregnancy outcomes were evaluated.

Results: Ninety three women were included. After treatment, more pregnancy continued into the second trimester, more live births and less numbers of abortions in group A and B in comparison with group C (p=0.008, 0.008 and 0.035) respectively. Maternal and neonatal outcomes were comparable in all studied regimens.

Conclusions: Management of women with unexplained first trimester habitual abortion (before 14 weeks) with intralipid or LMWH with small dose of aspirin may increase the proportion of pregnancy continued into the second trimester, more live births and less numbers of abortions. However, LMWH is more superior to the intralipid but with more side effect.

Open Access Original Research Article

Colour Doppler Ultrasound Versus CT Angiography or MR Angiography in Diagnosis of Lower Limb Ischaemia

Aya Talaat Ibrahim Abd El-Hamid, Abd Elmonem Nooman Darweesh, Mohamed Morsy ElWageih, Manal Fathy Hamesa

Journal of Advances in Medicine and Medical Research, Page 292-300
DOI: 10.9734/jammr/2021/v33i2331213

Background: Limb Ischemia is an obstruction of the arteries which reduces blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers, sores, or gangrene. The pain caused by ischaemia can -wake up an individual at night. This pain is often in the leg and can be relieved temporarily by hanging the leg over the bed or getting up to walk. The complications of diabetic vasculopathy commonly include two categories: microvascular and macro-vascular complications. Macro vascular disease is the most common reason of mortality and morbidity in diabetes and is responsible for high incidence of vascular diseases such as stroke, myocardial infarction, and peripheral vascular diseases (PAD). Epidemiological evidence has confirmed an association between diabetes and increased prevalence of PAD. The duration and severity of diabetes correlate with incidence and extent of PAD. Diabetes changes the nature of PAD.

Aim of the Work: The aim of this present study is to evaluate the role of colour Doppler Ultrasound (US) in the diagnosis of lower limb ischaemia.

Patients and Methods: In this study, 40 diabetic patients with ischemic limb underwent arterial reconstruction or intervention bypass surgery at Department of Diagnostic Radiology, Tanta University Hospitals. The age of our selected patients ranged from 40-80 years showing that about 2/3 patients in this study were above the age of 60 years and this was found in 24 patients (60%) this is due to high incidence of ischemia and prevalence of atherosclerosis in old age.

Results: There are variable risk factors were present. DM was present in 100% of patients followed by hypertension was found in 30 patients (75%) coronary heart disease was found in 9 patients (22.5%) and at least cigarettes smoking was found in 12 patients (30%). Regarding the clinical presentation, intermittent claudication pain was the most frequent symptoms and was present in 26 patients (65%), followed by persistent pain and delayed healing foot ulcer was present in 9 patients (22.5%), followed by rest pain was present in 4 patients (10%) at least amputated leg was present in one patient (2.5%). Colour Doppler US has some limitation eg. In ability to see particular vessels wall due to wall calcification, gases and vessels tortuously. Colour Doppler US sometimes failed to differentiate between tight stenosis and total occlusion. CTA still had an important role especially in the infra-popliteal region and peri-vascular masses.

Conclusion: Our study suggested that computed tomography angiography can be used to assess the entirety of lower extremity arterial inflow and runoff, with volumetric data that demonstrate robust arterial enhancement and minimal venous opacification. Nevertheless, computed tomography angiography cannot be considered a viable clinical alternative to colour Doppler US until its diagnostic accuracy and effectiveness are determined.

Open Access Original Research Article

Cardiac Function and Structure in Fetuses of Gestational and Pre-Gestational Mothers Suffering Diabetes

Mona Al Wakeel, Doaa El Amrousy, Nevine Mamdouh, Magdy Balaha, Amr Zoair

Journal of Advances in Medicine and Medical Research, Page 301-307
DOI: 10.9734/jammr/2021/v33i2331214

Background: The prevalence of maternal hyperglycemic disorders during pregnancy is increasing due to the obesity epidemic and increasing age of the pregnant mothers. This study aimed to assess the cardiac function and structure in fetuses of gestational and pre-gestational mothers suffering diabetes compared to those of healthy mothers using fetal echocardiography.

Methods: This cross-sectional study included a total number of 60 pregnant women, they were classified into three equal groups; group I included 20 pregnant women with pre-gestational diabetes mellitus (GDM), group II included 20 pregnant women with GDM, and group III included 20 healthy pregnant women as the control group. These women were subjected to complete history taking, laboratory investigations, and fetal echocardiography evaluation for cardiac function using M mode, 2 dimensional, and pulsed wave Doppler.

Results: Interventricular septum (IVS) as well as left ventricular (LV) wall thickness were significantly increased (p < 0.05) in mothers suffering diabetes compared to the healthy control group. Diabetes decreased LV diastolic function but did not affect LV systolic function. IVS thickness has a significant positive correlation (p < 0.05) with all indices of DM such as HbA1c, fasting blood glucose, and 2 hours postprandial glucose level. While mitral E-wave/A-wave ratio had a significant negative correlation (p < 0.05) with duration of DM.

Conclusions: IVS thickness is the most affected structures in fetal heart of mothers suffering diabetes. Moreover, LV diastolic function was affected in such fetuses unlike the systolic function. Fetal echocardiography in mothers suffering diabetes is highly important, not only to diagnose structural abnormalities but also for evaluation of cardiac function of the fetuses.

Open Access Original Research Article

Computed Tomography for Evaluation and Follow up of Hepatocellular Carcinoma after Microwave Ablation

Elzahraa Ismail Ahmed, El Shimaa Zakaria Al Shahawi, Nadia Mohammad Elwan, Manal Ezzat Badawy

Journal of Advances in Medicine and Medical Research, Page 308-316
DOI: 10.9734/jammr/2021/v33i2331215

Background: When surgical procedures are not possible, image-guided HCC tumor ablation provides curative treatment or acceptable therapeutic choices in appropriately selected patients. Post-ablation tumor response evaluation is critical for assessing treatment effectiveness and further therapy. Ultrasound (US) and Computed Tomography (CT) are critical in the follow-up of patients who have undergone liver thermal ablation therapy. The purpose of this study was to evaluate the role of computed tomography for evaluation and follow-up of hepatocellular carcinoma following Microwave ablation.

Methods: This prospective study was carried out on 30 patients radiologically proved with hepatocellular carcinoma.

Results: Triphasic CT imaging arterial phase revealed homogenous enhancement lesions in 46.7% of patients and heterogeneous enhancement in 53.35% of patients. All the lesions showed early washout in Porto venous and delayed phases with a patent portal vein in all patients. The diameter of the ablated area was different according to the duration of ablation. 60 W was applied for 8-10 minutes, resulting in ablation zones of 3.5-4 x 4.7-5.2 cm whereas applications of 60 W for 10-15 minutes resulted in ablation zones with a size of 4.5 - 5.5 x 5.6-6.5 cm. Triphasic CT was performed after 1 month and revealed that the success rate was 93.8% for tumors measuring ≤ 3cm 92.9% for tumors measuring 3-5cm. Local tumor progression was shown in 2 patients (6%) after 1 month, in 3 patients (10%) after 3 months, and in 5 patients (16.7%) after 6 months of follow-up. There was an intrahepatic distant recurrence in 9 patients (30%) after 1 month, in 15 patients (50%) after 3 months, and in 18 patients (60%) after 6 months of follow-up.

Conclusions: Percutaneous microwave ablation guided by ultrasound for the treatment of challenging HCC tumors up to 5 cm in diameter, including exophytic or subcapsular targets as well as those located in the hepatic dome or close to the diaphragm / hepatic hilum /heart, shown satisfactory efficacy and safety rates. For both technical and clinical success, selecting the proper approach is critical.

Open Access Review Article

Informed Consent for Surgical Care in East Africa

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 80-84
DOI: 10.9734/jammr/2021/v33i2331189

In the developed world one of the pillars of ethical conduct in surgical practise is informed surgical consent. In low income developing countries only a few researchers have explored the practise of surgical consent pre-operatively. During the informed consent process, the patient has a right to make an autonomous and independent decision about his/her surgical treatment after having been provided the necessary information by the surgeon caring for the patient. Patient autonomy and independent decision-making is recommended by the World Medical Association (WMA) Declaration of Lisbon. Family and cultural background, education, religion and socioeconomic status may all influence informed consent in surgical practise. In East Africa, few studies have reviewed consent practises among surgeons to document best surgical practise and identify areas that need improvement in the East African setting. This review reports the author’s personal experience of the practise of surgical consent among surgeons in Uganda and reviews the specific challenges faced in East Africa. In Uganda, the administration and documentation of informed consent is still inadequate. Better medical ethics education and proper communication skills training in medical schools needs to be addressed. Refresher courses on medical ethics and communication skills may also be necessary for fully trained surgeons.

Open Access Review Article

Potentials of Medicinal Plants with Antiviral Properties: The Need for a Paradigm Shift in Developing Novel Antivirals Against COVID-19

Peters Oluwale Oladosu, Njoku Moses, Obi Peter Adigwe, Henry Omoregie Egharevba

Journal of Advances in Medicine and Medical Research, Page 85-100
DOI: 10.9734/jammr/2021/v33i2331190

The menace of COVID-19 continues to ravage the world despite deployment of vaccines, and the development of oral antiviral pills whose effectiveness are still being evaluated. As the problems persist, Scientists are continuously searching for new resources and re-evaluating old ones that be used to effectively contain the pandemic. A search through literature has shown a huge amount of scientific resources in medicinal plant research which could be leverage.  Many medicinal plants have been demonstrated to possess various antiviral activities against influenza virus, SARS-CoV, herpes simplex virus, vesicular stomatitis virus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, simian immunodeficiency virus, echovirus, adenovirus, Newcastle disease virus, duck plague virus, measles virus, polio viruses, yellow fever viruses, Sindbis virus, human cytomegalovirus, Rift valley fever virus, feline herpesvirus, lumpy skin disease virus, and canine distemper virus. Medicinal plants are known to be a reservoir of bioactive compounds with useful pharmacological actives. This revision has identified one hundred and twelve (112) plants found with various antiviral activities. These plants cut across different families. An intriguing observation is the reported presence of antiviral in different classes of phytochemicals like alkaloids, flavonoids, tannins, anthraquinones, glucosides, polyphenols, saponins, essential oils, peptides and polysaccharides. There is the need for concerted paradigm shift to natural products of plant origin towards developing novel antiviral agents against COVID-19 especially with the reported safety challenge of adverse events and serious adverse events associated with already developed vaccines and pills.

Open Access Review Article

Mystery of Mesenteric Lymph Adenitis

R. Prathap, D. Ramachandra Reddy

Journal of Advances in Medicine and Medical Research, Page 153-158
DOI: 10.9734/jammr/2021/v33i2331197

The etiological factors are confusing for provisional diagnosis and the differential diagnosis of mesenteric lymph adenitis; it may be virus like Dengue, Herpes and Epstein - Barr virus. Bacterial infections like Tuberculosis of the intestine through contaminated unpasteurized cattle milk or Mycobacterium tuberculosis through infected swallowed sputum. T. Gondii, Yesinia enterocolitica, pseudo tuberculosis infection. Lupus vulgaris in the face at the mucocutaneous junctions is a reactivation of already existing tuberculosis facilitates clinical diagnosis. Fungal infections like mucor mycosis, aspergillus, Fusarium producing neutropenia, Histoplasma capsulatum, Cryptococcus aerosol infection from droppings of pigeons on the AC machines. Kikuchi-Fujimoto’s disease (KFD) .  Autoimmune causative factors. A study to reveal the mystery on patients with above symptoms and signs to rule out infections or a complication of follicular lymphoma.

Open Access Review Article

Thyroid Disorders and Diabetes Mellitus: Prevalence and Assosciation

Mai Hassan Hafez Ahmed, Rasha Mohammed Abd Elmageed Mohammed

Journal of Advances in Medicine and Medical Research, Page 220-228
DOI: 10.9734/jammr/2021/v33i2331205

Background: Diabetes mellitus and thyroid dysfunction are closely related. Numerous studies have reported an increased prevalence of thyroid disorders in diabetic patients, especially in type 1 diabetes mellitus.

Objectives: Therefore, the purpose of this review is to discuss the numerous underlying mechanisms behind the relationship between diabetes mellitus and thyroid dysfunction in order to demonstrate that the correlation between these two prevalent conditions is unlikely to be a coincidental finding.

Review: Diabetes and Thyroid disorders are characterized by endocrine system dysfunction. Thyroid hormones influence glucose metabolism in different ways, for example, they increase absorption of glucose from the gut, increase GLUT-2 level, regulate energy balance, and cause increased lipolysis which ultimately raises glucose levels in the body. Furthermore, thyroid hormones interact with adiponectin, leptin, ghrelin, to affect glucose metabolism. Additionally, studies suggest that hyperthyroidism impairs diabetic glycemic control, whereas hypothyroidism increases the risk of hypoglycemia, further complicating diabetes management.

Conclusion: This paper emphasizes thyroid abnormalities, if left untreated, can raise the risk of several diabetes complications including retinopathy, neuropathy, and nephropathy, and can worsen diabetic symptoms. As a result, treating subclinical hypothyroidism or hypothyroidism in diabetic individuals can be advantageous. Therefore, a systematic method for early thyroid testing in diabetic patients to avoid severe complications is highly recommended.