Open Access Case Report

Spontaneous Abortion in Pregnancies Having COVID-19 Infection in Bangladesh: A Series of Cases

Tanzina Iveen Chowdhury, Tasrina Rabia Choudhury, Md. Mostafizur Rahman, Nazma Akter, Nafisa Anwar Mariana, M. Jahangir Alam, Tripti Rani Das

Journal of Advances in Medicine and Medical Research, Page 150-157
DOI: 10.9734/jammr/2021/v33i2431230

Background: Coronavirus Disease (COVID-19) is a highly contagious disease and spreading all over the world. Pregnant women are particularly vulnerable to this infectious disease. There are not many reports on missed-abortion or stillbirths in COVID-19 that affected pregnant women. Twelve cases are presented here among a few cases of spontaneous abortion or fetal demise without having remarkable cause other than laboratory-confirmed COVID-19 (RT-PCR) from March 2020 to July 2020 in a single medical university hospital in Bangladesh.

Cases: Enrolled 12 pregnant subjects of fetal demise ≥11 weeks of gestation had COVID-19 infection (RT-PCR) and the specimen taken was nasal swab. 10 patients were admitted to the hospital and 2 patients were managed in their home under the supervision of Bangabandhu Sheikh Mujib Medical University (BSMMU). We excluded all the possible causes of clinical and obstetric causes of abortion other than COVID-19 infection. However, most of them were asymptomatic COVID-19 infection carriers, and only had a history of low-grade fever. 5 cases had a history of medical disorder which were controlled before pregnancy.

Conclusion: All the 12 cases did not have any clinical and obstetric disorder during pregnancy, but they all had COVID-19 infection. This suggests COVID-19 infection might induce fetal death through possible inflammation in the placenta.

Open Access Case Report

A 7-year Follow up of a Solitary Cyst on the Mandibular First Premolar: A Case Report

Hassan Dib, Said Halabi, Georges Aad, Antoine Berberi

Journal of Advances in Medicine and Medical Research, Page 193-198
DOI: 10.9734/jammr/2021/v33i2431235

Aims: The principal goal of the following case report is to shed light on the importance of thorough clinical, radiological and histological examinations in order to exhibit a final diagnosis of solitary bone cyst, as well as the importance of the surgical treatment for a better outcome.

Presentation of case:  A case of solitary cyst was identified accidentally in the mandibular right premolars’ region of an asymptomatic 14-year-old male patient post orthodontic consultation. Panoramic radiograph revealed a well-circumscribed, unilocular, radiolucent area giving a typical scalloped appearance between the roots of the involved teeth, that is, 43–44 (Federation Dentaire Internationale). The lesion was asymptomatic and no cervical lymphadenopathy was detected.

Discussion: Solitary bone cysts are infrequent mandibular cavities lacking epithelial coating and that are most commonly found in the posterior region of the lower jaw. They exhibit multiple names such as traumatic bone cyst, hemorrhagic bone cyst, extravasation cyst, progressive bone cavity and single chamber bone cyst. Solitary bone cysts are usually asymptomatic but may cause bone deformities, teeth displacement as well as pathological fractures of the affected region. Solitary bone cyst, also found in other skeletal locations, is often suspected after epidemiologic and radiologic test results and confirmed at surgery.

Conclusion: In solitary bone cysts cases, undoubtedly, the determinant factor is surgical exploration of the lesion, although its clinical characteristics and scientific literature descriptions must be borne in mind as well as the fact that histological and radiographic characteristics are important to sustain accurate diagnosis. Since etiology of these cysts is unknown to the present date, it can only be intuited according to personal characteristics of each patient. The most accepted theory suggested a traumatic origin for these lesions. Nevertheless, when trauma is discarded as etiologic factor, the most accepted theory would be related to calcium metabolism alterations associated to the overall condition of our patient.

Open Access Case Study

Immediate Tooth Autotransplantation into Fresh Extraction Sockets: A Case Series and Literature Review

Andreas Sakkas, Robert A. Mischkowski, Oliver C. Thiele

Journal of Advances in Medicine and Medical Research, Page 83-108
DOI: 10.9734/jammr/2021/v33i2431226

Autologous tooth transplantation has been used in various indications to replace missing teeth. In this case series, we investigated the long-term outcomes following immediate tooth autotransplantation into fresh extraction sockets in young individuals in our center. A consecutive retrospective study was conducted on patients treated at the clinic of Oral and Plastic Maxillofacial Surgery at Ludwigshafen hospital in Germany. Demographic factors, indication for tooth autotransplantation, donor site, and recipient site were extracted from patient records. The clinical and radiographic outcomes of 11 autotransplanted teeth were evaluated in a follow-up observation period ranging from 20 to 78 months. A total of 11 tooth transplantations were carried out in nine patients during the study period. Chronic apical periodontitis, non-restorable extended caries, hypodontia, ectopical eruption and accidental trauma were the reasons for tooth transplantation. Overall, nine third molars, one second molar, and one canine were autotransplanted. Donor teeth were mandibular third molars in seven cases, maxillary third molars in two cases, a maxillary second molar in one case, and a maxillary canine in one case. Six donor teeth had completely formed roots and five had incompletely developed roots and an open apex at the time of surgery. After a mean follow-up of 44 months, 10 cases (90.9%) were successful; one case failed because of root resorption and uneventful bone remodeling. In four cases, external root resorption was observed. No pulp revascularization was observed during the recall period. The survival rate and success rate of tooth autotransplantation were 90.9% and 63.6%, respectively. Our results are in agreement with other published observations. We conclude that autologous tooth transplantation into fresh extraction sockets in young individuals has a high long-term success rate. Although the indications for autotransplantation are quite narrow, careful patient selection coupled with an appropriate surgical technique can lead to exceptional long-term functional results.

Open Access Case Study

Sinonasal Anatomical Variations in Chronic Rhinosinusitis

Mohammed Moustafa Aboelyazeed, Mohamed Osama Tomoum, Hossam Sayed Elsherif, Ahmed Moawad Gamea

Journal of Advances in Medicine and Medical Research, Page 158-167
DOI: 10.9734/jammr/2021/v33i2431231

Background: There is a wide range of anatomical variations affecting the nose, paranasal sinuses (PNS). These variations may cause impairment of mucociliary drainage of the PNS resulting in sinusitis.

Aim: The aim of this study was to determine the incidence of anatomic variations of the different structures of the nose in a group of patients with chronic rhinosinusitis without nasal polyposis and compare them with cases didn’t have sinusitis.

Methods: This case control study included 140 patients who had diagnostic criteria of CRS according to EPOS 2020. Cases were collected from February 2020 to February 2021 from the outpatient clinic of Otorhinolaryngology Department of Tanta University Hospital. Patients were divided into two equal groups: The first group was the study group including 70 patients who had chronic rhinosinusitis as detected by Computed tomography (CT) of paranasal sinuses. The second group was the control group including 70 patients who had normal CT of paranasal sinuses.

Results: There was significant relation between the studied anatomical variations and chronic rhinosinusitis for Septal deviation, Haller cells, Supra agger frontal cell and Supra bulla frontal cell.

Conclusions: The relation between anatomical variations and sinusitis is not clear till now. Some studies showed statistically significant association between common anatomical variations and the presence of sinusitis while in other studies no statistically significant relationship. In our study there was significant statistical relation between Septal deviation, Haller cells, Supra agger frontal cell and Supra bulla frontal cell and chronic rhinosinusitis.

Open Access Case Study

Alveolar Ridge Splitting Technique with Simultaneous Implant Placement in Anterior Mandible for Removable Mandibular Implant Supported Prosthesis

Houssam Abou Hamdan, Georges Aoun

Journal of Advances in Medicine and Medical Research, Page 206-213
DOI: 10.9734/jammr/2021/v33i2431237

The aim of this study was to evaluate the behavior of the alveolar ridge split technique in a series of surgical cases in anterior mandible for two-implant retained overdenture. Twelve patients were included in this study. The surgeries took place under local anesthesia and consisted of a mid-crestal incision and subsequent bone management with a piezoelectric system. Once the approximately 3 mm expansion had been achieved, the implants were installed and present defects were filled with autogenous bone harvested from the bone crest with a bone scraper. There was a fracture of the bone plate in 3 cases, the fractured plates stabilized with osteosynthesis screws. In each case the implants were simultaneously placed. A total of 24 implants were placed. In the second surgery no implants were lost. It can be concluded that the bone splitting/expansion seem to be a reliable, predictable, relatively non-invasive technique and presenting limited intraoperative complications to correct narrow edentulous ridges.

Open Access Case Study

Gastroduodenal Strongyloidiasis Causing Protein Losing Enteropathy – A Case Report and Brief Review of Literature

S. Bharti, A. Singh, R. Kirti, N. Kumar

Journal of Advances in Medicine and Medical Research, Page 232-236
DOI: 10.9734/jammr/2021/v33i2431240

Strongyloidiasis is a common disease worldwide, has a complex life cycle and infect humans percutaneously. We report case of 46-year-old woman, presented with complaints of abdominal pain, and distension. She was on PPI (Proton Pump Inhibitors) for recurrent gastritis. She also  gives history of steroid intake for joint pain. USG abdomen showed moderate ascites. Upper GI endoscopy showed diffuse erythematous gastric mucosa with subtle mosaic pattern and edematous duodenal mucosa showing patchy erythema. Histopathological examination of gastric biopsy showed infestation by Strongyloides stercoralis, the gastric mucosal glands contained various parts of parasite. The patient recovered completely after course of antihelmintic drug.

Open Access Original Research Article

Role of Vitamin D Supplementation in Allergic Rhinitis

Mai Mohamed El Gharably, Mohammed Abdel-Rahman Amer, Mohamed Nasser El-Sheikh, Fatt-he Erfan

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2021/v33i2431217

Background: Allergic Rhinitis (AR) is one of the inflammatory diseases of the nasal mucosa, caused by immunoglobulin E (IgE) after allergens exposure, Severity measurement of the AR symptoms can be conducted subjectively by counting the total nasal symptom score (TNSS) and objectively by counting the serum IgE levels. Vitamin D (VD) plays a significant part in inborn and adaptive immunity; however, this is not completely understood. It is reported that over 900 genes are regulated by VD. The aim of this study is to assess the role of VD supplementation in AR.

Methods: This prospective randomized controlled study was carried out on 90 patients Test group (n = 45): received standard medications and supplementation of oral VD3 (cholecalciferol; 1000 IU) for 3 months. Control group (n = 45): received standard medications without supplementation of oral VD3.

Results: Comparison between both groups showed insignificant difference between both groups in VD level at the start of the study. According to TNSS in test group, there was significant improvement after 3 months compared to before the study. According to TNSS in control group, there was significant improvement after 3 months than before the study. There was significant improvement in test group than control group as regard to TNSS after 3 months.

Conclusions: There was highly significant reduction in the TNSS after VD supplementation. Thus, VD supplementation alters the course of AR towards clinical improvement.

Open Access Original Research Article

Drugs and Substances Reported in Emergency Department Presentations with Acute Recreational Drug / Substance Toxicity

Aisha Emad, Enas El Madah, Neven Hassan, Khaled Saad

Journal of Advances in Medicine and Medical Research, Page 9-13
DOI: 10.9734/jammr/2021/v33i2431218

Aims: To evaluate the self-reported drugs/substances in the emergency department presentations with acute recreational drug toxicity in a tertiary hospital.

Study Design: Cross sectional study.

Place and Duration of Study: Clinical Toxicology Department, Tanta University. Between January 2019 and December 2020.

Methodology: The data regarding the self-reported drug(s) / substance(s) in patients presenting to an Emergency Department in a tertiary hospital were collected and analyzed. The prevalence of each recreational drug/substance reported by the patients was calculated.

Results: There were 373 recreational drugs/substances reported by 248 cases. The most frequently self-reported drug(s)/substance(s) were ethanol (reported by 122 cases), followed by cocaine (94 cases), opiates (36 cases), cannabis (30 cases), and amphetamine-like stimulants (29 cases). Other drugs/substances as spice (synthetic cannabinoids), benzodiazepines, pregabalin, methadone, and  others were reported by the patients as well. In the remaining 16 of the total 264 cases (6.1%), the recreational drug(s) that had been used were unknown to or not reported by the patients.

Conclusion: In conclusion, this study revealed that in this tertiary hospital ED, the main recreational drugs leading to the ED presentation with acute recreational drug/substance toxicity as reported by the patients were ethanol followed by cocaine, opiates, cannabis and amphetamine-like stimulants. Other drugs/substances as spice (synthetic cannabinoids), benzodiazepines, pregabalin, methadone, and others were reported by the patients as well.

Open Access Original Research Article

Unrecognized Diaphragm Hernia

Khalid Elhattabi, Hasna Benghait, Zakaria Essaidi, Abdelilah Elbakouri, Mounir Bouali, Fatimazahra Bensardi, Abdelaziz Fadil

Journal of Advances in Medicine and Medical Research, Page 14-19
DOI: 10.9734/jammr/2021/v33i2431219

Introduction: Post-traumatic diaphragmatic hernia is defined as the passage of abdominal viscera into the thorax through a post-traumatic diaphragmatic breach. They are rare and may be unrecognized in 10-30% of cases at initial management.

Materials and Methods: A retrospective descriptive study including all the patients taken in charge for post-traumatic neglected diaphragmatic lesions over two years between December 2018 and January 2021 within the service of visceral emergencies of the universitary hospital center Ibn Rochd of Casablanca. Our work aims to define the epidemiological, clinical, and therapeutic characteristics of patients admitted for post-traumatic diaphragmatic lesions.

Results: The average age of the patients was 30 years (range 18 to 43 years). All patients were male. They were due to a closed trauma in 11 patients (32%) and a penetrating trauma in 58%. The diagnosis was guided preoperatively by the different imaging techniques, in particular chest radiography and CT scan. Treatment was mainly by laparotomy and consisted of closure of the diaphragmatic breach by simple sutures.

Conclusion: Post-traumatic diaphragmatic hernias can go unnoticed and can be life-threatening in case of associated lesions or complications. 

Open Access Original Research Article

Impact of Physician and Patient Education on Type 2 Diabetes Outcome in Primary Health Care Units, Al-Gharbiyah Governorate, Egypt

Hadeer Magdy Kamal Khalil, Noha Elsayed Esheba, Wael Farrag Mohammad, Laila Mahmoud Sayed Ahmed

Journal of Advances in Medicine and Medical Research, Page 20-27
DOI: 10.9734/jammr/2021/v33i2431220

Background: Diabetes mellitus (DM) leads to multiple complications that include macrovascular and microvascular complications. Proper management will result in decreased morbidity and mortality. The aim of this study was to evaluate the impact of Physicians and patients’ education on diabetes outcome in primary health care units, Al-Gharbiya Governorate, Egypt.

Methods: The study was carried out on primary health care physicians and their assigned patients in Al-Gharbiyah Governorate from October 2015 till October 2017. Study was carried-out in 2 phases. Phase 1 (Physician's phase): A sum of forty of primary health care physicians working in primary health care were recruited in the study. Phase 2 (Patient's phase): Those 200 patients were engaged in an educational program for self-management of diabetes using IDF (International Diabetes Federation) education maps.

Results: Knowledge and attitude of physicians were significantly higher after completion of educational program than Baseline. The mean Body mass index (BMI), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP)and Glycated HaemoglobinHbA1cafter 1 year and after 6 months were significantly lower than before and after 1 year than after 6 months. The number of patients who have exercised activities after 1 year and after 6 months were significantly higher than before and after 1 year than after 6 months.

Conclusions: The educational program applied in this study led to significant improvement of physician’s knowledge and attitude which helps in providing better care of diabetic patients. The educational program applied in this study led to significant improvement of diabetic patients’ lifestyle and outcome, which will subsequently lead to reduction in diabetic complications.

Open Access Original Research Article

Comparison of the Immunoglobulin Levels in Maternal and Cord Blood and Influence of Parity on Maternal Immunoglobulin Concentration in Port Harcourt, Nigeria

S. O. Ojeka, V. Z. Zabbey

Journal of Advances in Medicine and Medical Research, Page 28-33
DOI: 10.9734/jammr/2021/v33i2431221

Aim: This study was carried out to compare the immunoglobulin levels in maternal and cord blood and to find out if parity has any effect on the immunoglobulin concentration of the maternal blood.

Place and Duration of Study: Department of Human Physiology, Faculty of Basic Medical Sciences, University of Port Harcourt, between June 2018 and September 2019.

Methodology: A total of 25 paired maternal and cord serum was used for the study. About 5ml of venous blood was collected from mothers immediately after delivery and cord blood was also collected after the cord has been cut and the clamp released slightly to allow blood flow into a plain bottle. The serum levels of IgA, IgG and IgM were measured using Turbidimetric immunoassay method. 

Results: The mean IgA, IgM and IgG levels in maternal blood were 163.20 ± 13.35mg/dl, 88.16 ± 7.74 mg/dl and 351.60 ± 36.83 mg/dl respectively while their corresponding levels in the cord blood were 12.00±1.00mg/dl, 19.36 ± 1.67 and 300.60 ± 27.83 mg/dl respectively. The version 20.0 of the statistical package for social sciences (SPSS) and Microsoft Excel 2012 for the statistical analysis were employed for analyzing the various sets of data.

The Mean, standard errors of mean and ranges were determined for the different parameters for the two groups of subjects. The analysis of variance (ANOVA) was used to determine the variations between the subjects. The P-value of less than 0.05 was regarded as significant. The IgA and IgM showed significant variation in maternal and cord blood (P<0.05) while IgG showed no significant variation (P>0.05). Also, parity had no significant correlation with immunoglobulin concentration (P>0.05).

Conclusion: IgA and IgM concentrations were found to be significantly higher in maternal blood than in the cord blood, IgG showed no significant variation. There is a significant variation.

Open Access Original Research Article

Characteristics of Patients Undergoing Open Radical Cystectomy for Management of Muscle Invasive Bladder Cancer in A Tertiary Centre in Egypt

Mohammed Lotfi Amer, Mohamed Radwan, Ayman Hassan, Mohamed El-bendary

Journal of Advances in Medicine and Medical Research, Page 34-42
DOI: 10.9734/jammr/2021/v33i2431222

Aims: To represent the demographic and functional data of a cohort of patients with invasive bladder cancer managed with Open Radical Cystectomy (ORC) in the Urology Department of Tanta University Hospital between January 2019 and January 2021.

Methodology: A retrospective analysis was performed on the records of ORC for the period between January 2019 and January 2021. This cross-sectional study was done in the Urology Department, Tanta University Hospital in Egypt.

Results: Data of 47 patients were collected. Most of the patients in were males (34 patients (72.3%), with male to female ratio of 3:1. Most of the patients were either smokers or ex-smokers, while only 18 patients (38.3%) never smoked before. Visible hematuria was the most common symptom at presentation (35 patients) 74.5%. The main radiological imaging used for staging was CT Urography. Most of the tumors were urothelial in 66% of patients. Squamous differentiation was the most common non urothelial variant with 8 patients. The presence of other non-urothelial variant histology was present in 6 patients.

Conclusion: This study revealed that in the tertiary hospital of Tanta University, the mean age of patients presented with bladder cancer and undergoing ORC, was 63.5 years. Visible haematuria was the most common complaint reported. The use of MRI is valuable in staging of locally advanced bladder cancer. Most of the tumours were urothelial (66%) with significant reduction in the incidence of squamous cell bladder cancer than the previously reported data. Neoadjuvant chemotherapy has become an integral part of the treatment protocol in cases of muscle invasive bladder cancer.

Open Access Original Research Article

Effect of Rotating Shift on Biomarkers of Metabolic Syndrome and Inflammation among Health Personnel in Gaza Governorate

Heba Mohammed Arafat, Nahed Ali Al Laham, Ohood Mohammed Shamallakh, Kholoud Mohammed Shamallakh

Journal of Advances in Medicine and Medical Research, Page 43-59
DOI: 10.9734/jammr/2021/v33i2431223

Background: It's been suggested that shift employment is linked to an increased risk of metabolic syndrome (MetS). It is a complex syndrome that has been linked to the development of cardiovascular disease and/or type 2 diabetes mellitus. The goal of the study was to determine the prevalence of MetS among health-care workers and to investigate the impact of rotating shift work on MetS biomarkers and inflammation.

Methods: 100 current daytime workers were compared to 210 rotating shift workers in comparative analytical cross-sectional research involving 310 health care personnel. A questionnaire on socio-demographic (sex, age, marital status, job), health-related behaviors such as a physical activity) and occupational history about shift work, as well as a health examination with anthropometric and arterial blood pressure measurements, and laboratory investigations. For the diagnosis and determination of MetS, we used the Adult Treatment Protocol III National Cholesterol Education Program of America (ATPIII) indicators. SPSS version 20 was used for the statistical analysis.

Results: The overall prevalence of MetS among healthcare workers was 8.4% (9.0% among current daytime workers and 8.1% among rotating shift workers) with no significant difference between males and females, and shift category. Elevated C-reactive protein (44.5%) was the most commonly altered component among healthcare workers, followed by high triglyceride (35.5%), raised total cholesterol (24.8%), and elevated BMI>30 (20.6 %). In descending order, the following were the main risk factors for MetS in both sexes among rotating shift workers: high blood pressure (OR = 59.5; 95 percent CI, 16.4- 215.8), high fasting blood sugar (OR = 43.9; 95 percent CI, 12.9- 149.1), high triglyceride (OR = 42.3; 95 percent CI, 5.5- 326.6), obesity (BMI >30) (OR = 11.8; 95 percent CI, 4- 34.6), and low HDL cholesterol (OR = 1.6; 95 percent CI, 0.3- 6.1)

Conclusion: MetS was prevalent amongst Gaza Strip healthcare workers, with a consistent increase in prevalence as people were older and had a higher BMI. There was no direct relationship between shift category and the occurrence of MetS and inflammation; however, other factors such as genetics, lifestyle factors, and the work itself may have a greater impact than shift category.

Open Access Original Research Article

Comparative Study of the Incidence of Co-infection of Soil-transmitted Helminths and Helicobacter pylori among Children and Women of Reproductive Age Living in Slum Settlements in Rivers State, Nigeria

Evelyn Orevaeghene Onosakponome, Amudatu Ambali Adedokun, Clement Ugochukwu Nyenke

Journal of Advances in Medicine and Medical Research, Page 60-69
DOI: 10.9734/jammr/2021/v33i2431224

Background: Soil-transmitted parasites, bacterial and other biological contaminants constitute the major causes of food-borne diseases often transmitted through food and water borne routes contaminated with faeces in developing countries. Children and Women of reproductive age (WRA) have high of getting infected and being potential sources of pathogenic micro-organisms.

Objective: This study was aimed to assess and compare the prevalence and risk factors of soil-transmitted helminths and Helicobacter pylori (H. pylori) among school-aged children and women of reproductive age at selected area in Eleme Local Government Area, Rivers State.

Methods: Cross-sectional study was conducted 580 participants were enrolled in May-August 2019. The gastrointestinal parasites were examined with wet mount and formol-ether concentration techniques. Chi-square (χ2) test was used to evaluate the association between categorical variables and infection prevalence using SPSS version 21, values were considered significant when the p-value was less than 0.05.

Results: The overall prevalence of soil-transmitted helminths among children was 12.3% (37/300) whereas WRA had 12.5% (35/280). Trichuris trichura was found to be prominent among the children with 18 (6.0%) while Ascaris lumbricoides 10 (3.6%) was most prevalent among WRA. Gender based Prevalence was 56.8% (21/37) and 43.2% (16/37%) for males and females respectively. The age-related prevalence is most common among age group 11-15 years. This prevalence was not statistically significant (p>0.05). H. pylori infection prevalence among the children and WRA were 11.7% (35/300) and 26.8% (75/280). The gender-related prevalence among the males had 18 (51.4%) and females 17 (48.6%) of the children group. The age group 1-5 years showed high prevalence of H. pylori than other groups. Among WRA, age group 23-27 and 33-37 years had equal prevalence of 20 (26.7%). In consideration of co-infection between children and WRA, A. lumbricoides coinfection H. pylori 15 (53.5%) was most prevalent among children while among women of reproductive age, hookworm co-infection H. pylori 8 (50.0%) was most prevalent. Risk factors that were statistically significant (p<0.05) were among those who wash hands with soap after playing/touching soil and those dewormed in the last three months.

Conclusion: The distribution of soil-transmitted helminth infections co-infection H. pylori among children and WRA is low, however strategic planning of treatment regimen of community based should be encouraged.

Open Access Original Research Article

Correlation between Late Second and Third Trimester Placental Thickness Detected by Ultrasound and Gestational Age in Normal and IUGR Pregnancies

Basma M. Elmahdy, Amal A. El sokary, Adel E. AlGergawy, Dina G. El Kholy

Journal of Advances in Medicine and Medical Research, Page 70-82
DOI: 10.9734/jammr/2021/v33i2431225

Background: Ultrasonography has played a significant part in obstetric care. This has progressed from basic 2-D imaging to Doppler imaging to monitor foetal and maternal circulation, as well as 3-D imaging of foetal anatomy .).Obstetrical ultrasound has proven crucial in a variety of ways, two in particular being more accurate pregnancy dating and detection of fetal anomalies. The aim of this study is determine to Correlation between late second and third trimester placental thickness detected by ultrasound and gestational age in normal and IUGR pregnancies.

Methods: This study was a prospective study that was conducted on100 pregnant women who attended the outpatient clinics or admitted at inpatients wards of Obstetrics and Gynecology department, Tanta University during the period from December 2019 to December 2020.

Results In the majority of gestational age groups, the mean placental thickness was lower in group I than that detected in group II (P<0.01) except that detected between 28 and 29 weeks and 29 and 30 weeks, where there was no significant difference between two studied groups regarding placental thickness (P>0.05). In addition, the present study indicated that 26 out of 50 (52%) of newborns in group I had a birth weight below the fifth percentile and 24% of them had a birth weight ranged between 5 th -10 th percentile for gestational age and sex at the time of birth whereas all newborns of group II had a birth weight >10th percentile for gestational age and sex. A comparison of neonates’ birth characteristics and outcomes between two groups showed a statistically significant difference in the birth weight among both studied groups

Conclusions: The mean placental thickness was steadily increased with increased gestational age both IUGR and normal fetal weight cases. in addition, In the majority of gestational age groups, the mean placental thickness was lower in IUGR than that their normal weight conterparts.

Open Access Original Research Article

Epidemiological Profile of Stroke patients at Neuropsychiatry Department, Tanta University Hospitals

Samar Samir Alnamla, Ashraf Ali Aboelsafa, Abdelaziz Farouk Eldeeb, Nadira Mansour Hassan

Journal of Advances in Medicine and Medical Research, Page 109-122
DOI: 10.9734/jammr/2021/v33i2431227

Background: Stroke is the second most common cause of death and long-term disability worldwide with up to one of every six survivors remaining permanently disabled. It is a devastating and disabling cerebrovascular disease with significant amount of residual deficit leading to economic loss and disease burden worldwide.

Aim: Describe the epidemiological profile of stroke during the period of five years (2014-2018).

Study Design: cross- sectional study.

Place and Duration of Study: This study was carried out in the Neuro-psychiatry hospital (free and economic departments) at Tanta University Hospital. This study started from the first of April 2019 and completed by July2021.

 Methodology: The sample we included 3435patient medical records. Tools of the study were: file extracted sheets of the five years (2014-2018).It was about data related to epidemiological profile of stroke.

Results: This study included 3435patient medical records admitted with stroke at the years2014-2018 and had the following epidemiological profile: the age ranged from 30-95 years and the median age was 65 years old .Male constituted 51.8% of patients, about two thirds, (64.9%) of patients were from urban residence and 66.8%were married. As regards type of stroke: ischemic stroke presented by 63.5%of patients and hemorrhagic stroke by 36.5%.Of all patients 30% had favorable outcome, 67.4% had stable condition and 2.7% were died.

Conclusion: The rate of stroke was increasing through the studied five years with most cases at year 2018 and the epidemiological profile was not different from other studies.

Open Access Original Research Article

Relationship of C-reactive Protein to Lymphocyte Ratio with Prognosis and Mortality in COVİD 19

Bayrakçi Onur, Bayrakçi Sinem

Journal of Advances in Medicine and Medical Research, Page 123-127
DOI: 10.9734/jammr/2021/v33i2431228

Background: The Covid 19 pandemic is a serious disease that has infected millions of people and died tens of thousands. The clinical findings of the disease is observed in a wide range from asymptomatic to death. On the other hand, abnormal pathological variety is findings in laboratory parameters.

Aims: In this study, it was aimed to relation  laboratory parameters with prognosis and mortality in the admission intensive care.

Study Design: This study was done in Ersin Arslan Training and Research Hospital Covid Intensive-care unit between July 1, 2021 and September 30, 2021.

Methodology: Patients over the age of 18 who were positive Polymerase Chain Reaction test and admitted in the intensive-care unit were included in the study. The data of a total of 197 patients who were compatible with this criteria was retrospectively analyzed. White blood cells, C-reactive protein, procalcitonin and lymphocyte values (within the first 24 hours) ​​of the patients, use history of steroid, and whether they were intubated and their mortality were investigated.The relations of the obtained data with each other were evaluated. Statistical analysis was performed using the Wilcoxon Signed-Rank test.

Results: 113 were males (57.3%), and 84 were females (42.7%). The mean age was 64.6 ±2.16 (21-95) years.  Most of the patients (67.5%) were over 60 years old. WBC values ​​of the patients were 46.8% high and 53.2% normal (normal value range 4-10 μL). Lymphocyte values were 55.3% lymphopenia, 43.6% normal lymphocytes, 1.1% lymphocytosis (normal value range 0.8-4 μL). CRP results were 98.9% high (normal value range 0-5 mg/L). High PCT value was 26.3% of the patients (normal value range 0-0.5 ng/ml). 86.8% of the patients were used steroids. 58.3% intubated (in Intensive-care unit) and 54.8% died of the patients. According to the lower and upper reference values; WBC/Lymphocyte:1-12.5 and CRP/Lymphocyte: 0-6.25 values ​​were accepted normal ranges.

Conclusion: Mortality is more often in patients with females and over 60 years of age admitted to the intensive-care unit in Covid-19. If the CRP to Lymphocyte ratio is more than 100, it is related with mortality.

Open Access Original Research Article

Survival Outcomes of Histopathological Subtypes of Colorectal Adenocarcinoma in Ugandan Patients

Richard Wismayer, Julius Kiwanuka, Henry Wabinga, Michael Odida

Journal of Advances in Medicine and Medical Research, Page 128-149
DOI: 10.9734/jammr/2021/v33i2431229

Background:  High grade mucinous adenocarcinomas have been found to be more common in younger patients and are associated with a poor prognosis in the West. In Uganda, survival outcomes of the different histopathologic subtypes of colorectal adenocarcinoma (CRC) and lymphovascular invasion (LVI) is unknown. We determined the survival outcome of the different histopathologic subtypes of CRC and LVI among Ugandan patients.

Methods: A retroprospective cohort study on patients diagnosed with CRC from 2008 to 2018 were identified from the Kampala Cancer Registry and hospital medical records. Retrieved data included date of diagnosis, demographics, stage, grade and location of CRC. Our outcome was survival, and the main predictor variables were the histopathologic subtype, stage, grade and LVI. We plotted Kaplan-Meier curves for survival, tested the equality of survival by log-rank tests and used multivariable Cox regression to determine factors associated with survival.

Results: 12.4% patients predominantly had mucinous adenocarcinoma/signet ring colorectal carcinoma (MAC/SRCC) and 87.6% patients had classical adenocarcinoma (AC). The median age (SD) at diagnosis of MAC/SRCC was 47.8 (16.6) years and 53.8 (15.9) years for AC. SRCC/MAC was significantly associated with more LVI than AC (p=0.002).  In multivariate analysis, factors associated with increased mortality included stage III (aHR=2.56; p=0.009) and stage IV (aHR=6.64; p <0.001). After adjusting for lymph node involvement and metastasis, SRCC/MAC patients had a shorter survival than AC patients; however, this difference was not statistically significant (p=0.229).

Conclusions: In Uganda, the proportion of MAC is similar to that found in the Western world. SRCC/ MAC were associated with more LVI than AC. SRCC/MAC showed a tendency towards decreased overall survival. In Uganda, more patients present with advanced-stage CRC which was associated with poor survival hence national screening guidelines are necessary to improve survival.

Open Access Original Research Article

Hand Washing and Other Hygienic Cord Care Practices among Mothers in Nnewi, Nigeria

C. U. Onubogu, E. F. Ugochukwu, F. A. Ifiora, U. O. Onwumere, K. N. Okeke, E. N. Umeadi

Journal of Advances in Medicine and Medical Research, Page 168-176
DOI: 10.9734/jammr/2021/v33i2431232

Background:  Neonatal sepsis is a major contributor to the high burden of neonatal deaths in sub-Saharan African countries like Nigeria. Hygienic cord care has the potential to reduce neonatal mortality from infections.

Aim: We examined the rate of hand washing and other hygienic cord care practices among mothers in Nnewi Nigeria.

Methods: A cross-sectional study was conducted among 214 consenting mothers who had a biologic child less than one year of age. Mothers were interviewed using semi-structured interviewer-administered questionnaire. The major outcome variables were practice of hand washing and other indicators of hygienic cord care such as frequency of cord care, cord care after diaper change, re-use of swabs and method of cord care. Data was analyzed using SPSS version 21. P-value < 0.05 was considered statistically significant.

Results: The mean age of the mothers was 29.6 ± 5.53 years. The rate of hand washing before, after, both before and after, and neither before nor after cord care were 81.3%, 76.2%, 68.7% and 11.2%, respectively. Majority of the mothers practiced cord care activities for ≥3 times (79.9%), did not re-use swabs for cleaning the cord (92.5%) and used methylated spirit for cord care (89.3%). However, only one mother (0.5%) used chlorhexidine gel for cord care while half did not practice cord care after diaper change. Factors significantly associated with practice of hand washing before and after cord care were access to health education during pregnancy, knowledge of the consequence of poor cord care, and use of antiseptic agent for cord care.

The respondents had a fairly good practice of hygienic cord care. However, many babies still faced the risk of sepsis due to failure of their mothers to practice hand washing both before and after cord care, and after diaper change as recommended. Intensive promotion of hygienic cord care recommendations is endorsed.

Open Access Original Research Article

A Comparative Study between the effect of Pentoxifylline and Low Dose Aspirin on Uterine Artery Blood Flow in Patients with Unexplained Infertility

Nourhan Shaaban Ali, Ayman Abd El-Aziz El-Dorf, Shahinaz Hamdy El-Shorbagy, Ashraf El Mohamady Gharib

Journal of Advances in Medicine and Medical Research, Page 177-184
DOI: 10.9734/jammr/2021/v33i2431233

Background: Infertility is customarily defined as the inability to conceive after 1 year of regular unprotected intercourse. The Practice Committee of the American Society for Reproductive Medicine (ASRM) has published guidelines for a standard infertility evaluation. It includes a semen analysis, assessment of ovulation, a hysterosalpingogram, and, if indicated, tests for ovarian reserve and laparoscopy. The aim of this study was to compare the possible changes in uterine artery doppler indices after the use of pentoxifylline and low dose aspirin in patients with unexplained fertility.

Methods: This prospective comparative clinical study was conducted on patients age between 20 and 35 years old, body mass index (BMI) from 18 – 25 kg/m2, with unexplained infertility. Patients were divided into two equal groups: low dose aspirin group and pentoxifylline group. All patients were subjected to personal, husband, sexual and menstrual history taking, clinical examination, routine infertility investigations [Husband semen analysis, Hormonal investigation (FSH, LH, midluteal progesterone, prolactin, TSH)], hysterosalpingogram, laparoscope and transvaginal ultrasound.

Results: There was no significant difference between both groups regarding age, BMI, occupation, residency, parity, type/duration of infertility, menstrual regularity/amount, dysmenorrhea, sexual intercourse frequency, using of lubricant or vaginal douching. There was no significant difference between the studied groups regarding FSH, LH, TSH, basal uterine artery RI and PI and S/D ratio at one and three months.

Conclusions: In women with unexplained infertility, there was no significant difference between the effect of pentoxifylline and low dose aspirin on the uterine artery blood flow or Doppler indices (RI, PI and S/D ratio).

Open Access Original Research Article

Effect of Laparoscopic Ovarian Drilling on Doppler Pattern in Patients with Clomiphene Citrate_ Resistant Polycystic Ovarian Syndrome

Nada K. Tawfik, Mohamed A. El sharawy, Hossam A. Zyton, Ahmed T. Soliman

Journal of Advances in Medicine and Medical Research, Page 185-192
DOI: 10.9734/jammr/2021/v33i2431234

Background: Polycystic ovarian syndrome (PCOs) is a prevalent endocrine condition affecting women throughout their reproductive years. It is the most common cause of ovulation-related infertility, accounting for around 75% of instances of anovulatory infertility. The goal of this study is to see how laparoscopic ovarian drilling affects the Doppler pattern in patients with clomiphene citrate-resistant polycystic ovarian syndrome.

Methods: 50 patients were included, diagnosed as PCO patients according to Rotterdam criteria, 2003 and were planned for LOD.

Results: This study was done at 50 patients was with mean age 29 year, Mean BMI 27.28 Kg/m2,Mean duration of infertility 3.71 years. there were statistically significant decrease in ovarian stromal VI ,FI,VFI and PSV postoperatively, But there was statistically significant increase in ovarian stromal RI postoperatively.

Conclusion: ovarian stromal blood flow indices significantly changed after LOD. Our results provide a potential avenue for evaluation of ovarian stromal blood flow changes after LOD.

Open Access Original Research Article

Dietary Habits and Adherence to Dietary Approaches to Treat Hypertension in Adults with High Blood Pressure: CSS

Amira Kamar Eldawla Mokhtar El-Shinawey, Loai Mohamad Al Ahwal, Abdelaziz Farouk Eldeeb, Nadira Mansour Hassan

Journal of Advances in Medicine and Medical Research, Page 199-205
DOI: 10.9734/jammr/2021/v33i2431236

Context: Hypertension is a worldwide burden which causes severe complications. Dietary and lifestyle modifications are important for lowering high blood pressure.

Aim: To identify the dietary intake and habits among hypertensive patients in order to treat hypertension in adults with high blood pressure.

Subjects and Methods: Design: A cross-sectional study was used. Settings: This study was carried out in the Internal Medicine outpatient clinic in a University Hospital. It was a cross-sectional study.

Methods and Materials: A pre-designed validated questionnaire was used to collect the necessary data. The study included 350 hypertensive patients who were subjected to nutritional assessment.

Results: Most patients had positive family history of hypertension where half of them suffered it for less than 5 years. 92.6% of them were regularly treated, while 47.1% suffered from chronic diseases (mainly DM 35.1%). Unsuitable dietary intake compared to recommended daily intake was prevalent in most of the patients.

Conclusions: Unhealthy dietary habits and poor adequacy of recommended daily intakes of different nutrients were found among the studied hypertensive patients.

Open Access Original Research Article

Adult Scoliosis: Surgical Outcomes

Ahmed Anas Zahra, Ahmed Abd El Aziz Elsharkay, Ebrahim Ahmed Shamhoot, Ibrahim Mohamed Shafik, Ali Ibrahim Seif Eldein

Journal of Advances in Medicine and Medical Research, Page 214-226
DOI: 10.9734/jammr/2021/v33i2431238

Background: Adult scoliosis is a common spine deformity. It is very debilitating to daily activities of the patients. Surgical management requires a clear assessment of the functional impact of scoliosis, the failure of conservative treatments and precise analysis of radiological investigations (full spine views, dynamic X-rays and MRI). The back pain was the main complaint as it was the main presentation. The aim of the work is to assess the outcomes of surgical procedures in patients with adult scoliosis.

Methods: This prospective study was conducted on 30 patients with adult scoliosis with cobb angel more than 10 degrees. Surgical techniques (anterior and posterior approaches, decompression, osteotomies, fusion, and instrumentation) done and tailored to each patient. Decompression alone found usually not enough, fusion needed almost in all cases.

Results: Patient disability using Oswestry disability index assessed before and after intervention.  Also a good, accepted change achieved as 15 patients restore about 75% of their abilities ,7 patients restore more than 50% of their usual ability,3 patients restore about 25% of their usual ability. Cobb’s angel before intervention was 6 cases < 60 degrees,14 cases between 50 and 60 degrees and 10 cases between 40 and 50 degrees became 14 cases between 10 and 0 degrees, and 10 cases between 10 and 20 degrees. Surgical treatment of adult scoliosis is associated with a better quality of life for patients when good selection of the patient and maneuvers done. Visual analogue scale before and postoperative, and three and six months later detect ,a good result achieved, As VAS before intervention was ; 20 patients from 9 to 10,9 patients from 6 to 8, one patient from 3 to 5. VAS post-operative after sex months became only four patients from 6 to 8, twenty four patients from 3 to 5and only two patients from 0 to 2.

Conclusions: Surgical management of adult scoliosis become more applicable, Spine managed as one unit, Correction of coronal and sagittal malalignment done together, Do not neglect one of them. Using both free hand , c arm and even navigator when needed help in good outcomes and complications avoidance, management strategy differ according many factors, The technique requires proper selection of cases before surgery and meticulous attention during surgery to identify the correct starting point, screw orientation and screw length selection. Surgical outcomes of adult scoliosis clinical, radiological and neurological outcome were satisfied without major complications.

Open Access Original Research Article

Health Workers and Users’ Perspective of Quality of Maternal Health Care in Health Facilities in Somali Region of Ethiopia: A Qualitative Study

Olusola Oladeji, Abdifatah Elmi Farah

Journal of Advances in Medicine and Medical Research, Page 237-248
DOI: 10.9734/jammr/2021/v33i2431241

Aims: In spite of   progress made in reducing maternal mortality, there remains a high burden of deaths related to the quality of care mothers receive in low- and middle-income countries. Ethiopia health sector transformation plan focused on improving equity and quality of health care at all levels of the system. The study explored health workers and users’ perspectives of quality of maternal health care in health facilities in Somali Region.

Study Design: This was a descriptive study.

Place and Duration of Study: Somali Region of Ethiopia in October 2021.

Methodology: A qualitative, descriptive design conducted in four project woredas in the region selected using multistage sampling technique. The participants were 23 health workers (health facility providers and health administrators) and 20 pregnant and lactating women purposefully identified and recruited based on their knowledge of maternal health care delivery in the study sites. The WHO framework for quality of maternal and newborn health care was used for the in-depth interviews and focus group discussions.

Results: The health workers had knowledge about what constitutes quality health care which include availability of adequate human resources, drugs and equipment, patient satisfaction and improved service utilization, effective referral services and use of clinical guidelines. Compassionate, respectful and caring health workforce was considered by the users as a major component of quality of care. Three major barriers to providing quality of care in the health facilities were human resource (shortage and high turnover of health workers, poor motivation, poor use of clinical guidelines), management constraints (limited training, and supervision, weak ambulance services for referral) and material constraints (shortage of medical supplies/drugs, equipment  and infrastructure).

Conclusion: To ensure quality of maternal and newborn care, the identified barriers should be addressed focusing on the key priority areas.

Open Access Original Research Article

Triceps Reflection versus Olecranon Osteotomy Approach in Supracondylar Intercondylar Distal Humeral Fractures Managed by Open Reduction and Internal Fixation in Adults

Walid Samy Fathi Mohamed, Mohamed Shafik Saaid, Ashraf Atif Mohamed, Ali Mahmoud Emran

Journal of Advances in Medicine and Medical Research, Page 249-257
DOI: 10.9734/jammr/2021/v33i2431242

Background: Intercondylar fracture humerus needs early treatment consequently, the surgical approach becomes very crucial. Many approaches have been described for this fracture type. Approaches such as triceps-reflecting and olecranon osteotomy are frequently used.

Aim of Work: Is to assess the functional and radiological outcomes of olecranon osteotomy and triceps reflection in adults with supracondylar intercondylar distal humerus fractures treated with double plating.

Patients and Methods: To achieve the study's goal, a non-randomized controlled clinical trial was used. Patients with supracondylar intercondylar humerus fractures were admitted to Tanta University's orthopedic department and Cairo's El-Helal hospital. Total number of cases (21 patients) included in the study as a thorough sample during the research period (6 months). The medical records and radiographs of 13 male and 8 female patients, all above the age of 18, were prospectively evaluated after a 6-month follow-up period. Triceps reflection was performed on 52.4 percent of patients, while olecranon osteotomy was performed on 47.6 percent. The results of treatment were evaluated using a modified version of Mayo-Elbow performance score (MEPS).

Results: All the patients were assessed both before and after surgery. In the triceps-reflection group, 9 patients regarded good, 1 got excellent, and 1 got fair MEPS, whereas in the olecranon-osteotomy group, 7 patients got good, 1 got fair, and 2 got excellent MEPS. The olecranon-osteotomy technique gives greater control over the elbow joint and better visualization, especially if with C3 type. The functional results of distal humerus fractures disclosed by the triceps-reflection and olecranon-osteotomy approaches were comparable.

Conclusion: In C3 type, the olecranon-osteotomy technique offers more control over the elbow joint and better visualization, whereas in other types, the triceps-reflection and olecranon-osteotomy approaches, in treatment of supracondylar intercondylar distal humerus fractures with triceps-reflection and olecranon-osteotomy both methods are safe.

Open Access Review Article

Implications and Considerations for Analysis of Inflammatory Markers in the Red Cell Concentrates of Borderline Diabetic Blood Donors

Vanessa Zammit, Alexandra Cutajar, Byron Baron

Journal of Advances in Medicine and Medical Research, Page 227-231
DOI: 10.9734/jammr/2021/v33i2431239

Storage lesions of blood products intended for transfusion have been shown to give rise to the accumulation of proin flammatory cytokines, which are known to cause transfusion associated adverse events and immunomodulatory effects. Regulations which determine the eligibility of blood donors do not take into consideration metabolic disorders such as Type 2 Diabetes Mellitus (T2DM), unless complications arise from said disorder. However, the increased levels of cytokines in T2DM classifies this condition as an inflammatory condition. This outcome dictates the need to investigate whether detected levels of pro-inflammatory cytokines due to inflammation combined with those present in red cell concentrates as a result of storage lesions may lead to undesirable outcomes in recipients who already have underlying inflammatory conditions. Due to the largely unavailable information on the subject, a few important considerations for undertaking such investigations have been summarised.