Open Access Study Protocol

The Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Plane Block after Hip Arthroplasty

Eman A. Elrefaey, Motaz M. Abosabaa, Nagat S. Elshmaa, Abdelaziz H. El Badawi

Journal of Advances in Medicine and Medical Research, Page 99-107
DOI: 10.9734/jammr/2022/v34i331277

Hip fractures are a persistent health problem especially post-operative with morbidity disability and mortality. The fascia iliaca nerve block (also called the fascia iliaca compartment nerve block) is considered an alternative to a femoral nerve or a lumbar plexus nerve block.

Objective: This study aims to evaluate the analgesic efficacy of ultrasound-guided fascia iliaca plane block after hip arthroplasty.

The Primary Outcome: average postoperative VAS pain scores.

Secondary Outcome: Time to first analgesic request; Postoperative analgesic consumption; Overall patient satisfaction with analgesia; Any adverse effects e.g., nausea, vomiting, pruritus, or urinary retention.

Patients and Methods: This Prospective randomized double-blinded clinical trial will be carried out in Tanta University Hospital in Orthopedic Surgery Department. The study included 60 adult patients aged > 25 years; ASA class I & II scheduled for total hip arthroplasty surgery.

Results: As regards, the first analgesic requirement of analgesic there were significant statistical increases in group I compared to group II. also, there were statistically significant decreases in total consumption of both paracetamol and pethidine in the group, however, There were significant statistical decreases in total pethidine consumption (mg) in group I compared to group II

Conclusion: FICB is safe and effective in improving postoperative pain after hip arthroplasty. It provides lower NRS, more hemodynamic stability, a longer time for 1st time of analgesics requirement ad a lower amount of total analgesic consumption within 1st 24 hours.

Open Access Original Research Article

Comparative Assessment of Iron Deficiency Anaemia among Chronic Kidney Disease Subjects in Niger Delta Nigeria

Lenox-Prince, Tamunonengiye-ofori, Jeremiah, Awortu Zacchaeus, Eze Evelyn Mgbeoma, Echonwere-Uwikor, Beauty Eruchi, Moore-Igwe, Beatrice, Mordi, Augustina Ngozi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2022/v34i331267

Iron Deficiency Anaemia which is reduced red blood cells due to iron deficiency had been reported to be a major challenge among Chronic Kidney Disease patients. The cause of anaemia in these patients is multifactorial, ranging from the inability of the kidneys to excrete hepcidin to even the inability of the kidneys to produce erythropoietin. This study aimed at comparatively assessing IDA between CKD and APHS in Niger Delta. A total of 88 subjects were recruited, 55(62.50%) CKDP and 33(37.50%) Control subjects. Samples were collected and analysed for IDA Indicators  such as Serum Hepcidin Levels using commercial DRG Hepcidin-25 kit and other Haematological Indices using Automation (Sysmex KX-21N Automated Haematology Analyzer), Leishman Staining Technique and Supravital Staining Technique; Questionnaire was also used to obtain some data,  data obtained were analysed using SPSS version 21.The mean values for  Serum Hepcidin, Haemoglobin(HB), Packed Cell Volume(PCV), Red Blood Cell count(RBC), Mean Cell Volume(MCV), Mean Cell Haemoglobin(MCH), Mean Cell Haemoglobin Concentration(MCHC), Reticulocyte count(Retics) and Red Cell Distribution Width(RDW) were 52.00ng/ml, 10.00 g/dL, 31.00%, 3.74×102/L, 78.84fL, 26.58pg, 31.79g/dL, 0.64%, and 14.94% respectively in the CKD patients while that for the APHS were 16.00ng/ml, 14.00g/dL, 42.00%, 4.69×1012/L, 89.37fL, 29.59pg, 33.00g/dL, 1.09% and 13.20% respectively. Statistical T-Test of significance revealed that Serum Hepcidin level was elevated significantly in CKD patients (52.00ng/ml) when compared with APHS(16.00ng/ml) t86= 6.54, p<0.05, Haemoglobin value of 10.00g/dL in CKD patients was significantly lower than 14.00g/dL in APHS (t86 = -8.49, p<0.05), and the values of other haematological indices were lower except RDW that was elevated significantly among CKD patients when compared with the APHS (p<0.05) all at significance  level of 0.05. The elevated serum hepcidin and RDW level seen in this study  may be as a result of diminished renal clearance and inflammatory state of the kidney. The kidney”s inability to make enough erythropoietin may have lead to the low red blood cell count that consequently caused anaemia in subjects studied..The estimation of Serum Hepcidin level in CKD patients in addition to the other Haematological indices will improve the diagnosis, treatment and management of Iron Deficiency Anaemia in these patients.

Open Access Original Research Article

Outcome of Neonates Born through Meconium Stained Amniotic Fluid in a Tertiary Care Hospital, PAK Emirates Military Hospital Rawalpindi, Pakistan

Saeed Ullah, Muhammad Tariq Nadeem, Bakth Jamal, Ikram Alam, Muhammad Qasim Khan, Kiramat Ullah, Khalil Ahmad

Journal of Advances in Medicine and Medical Research, Page 7-12
DOI: 10.9734/jammr/2022/v34i331268

Objective: The study was conducted on the incidence of meconium aspiration syndrome which is still high in the developing world and contributing significantly to the neonatal mortality. The study was aimed to know the risk factors contributing to meconium aspiration syndrome and neonatal outcome in a tertiary hospital (Punjab) Department of pediatric Medicine PAK Emirates Military hospital Rawalpindi in the Pakistan.

Materials and Methods: It was a hospital based cross sectional study This descriptive case series was carried at Department of Peadiatric Medicine PAK Emirates Military hospital Rawalpindi in the Pakistan over a period of one year, from Jan 2019 to Dec 2020, involving 2820 patients; All live newborns born through meconium-stained liquor were enrolled and all the details regarding the mother and neonate were recorded. Odd’s ratio and bivariate analysis was done to assess the risk factors for meconium aspiration syndrome.

Results: Out of all the deliveries 12.4% were born through meconium-stained amniotic fluid and meconium aspiration syndrome developed in 5 .6% of the neonates. Low Apgar score and premature rupture of membranes was significantly associated with the risk of occurrence of meconium aspiration syndrome. Neonates who developed meconium aspiration syndrome had mortality of 6.7%

Conclusion: The Perinatal asphyxia and premature rupture of membranes were significantly associated with the development of meconium aspiration syndrome and neonates who developed meconium aspiration syndrome had high mortality.

Open Access Original Research Article

Clinicopathologic Predictors of Pathologic Complete Response after Neoadjuvant Systemic Therapy and Impact on Surgical Management

Rabia Niaz, Rufina Soomro

Journal of Advances in Medicine and Medical Research, Page 13-21
DOI: 10.9734/jammr/2022/v34i331269

Neoadjuvant systemic therapy previously given for inoperable breast cancer is increasingly being administered in early breast cancer especially in triple negative and HER2 positive molecular subtypes. It is associated with an increased rate of complete pathologic response (PCR) which is a surrogate marker for good survival outcomes and has role in de escalation of surgical management.  We conduct this study to identify clinical and pathologic factors and systemic treatment regimens that predict PCR among Pakistan’s breast cancer patients and its impact on surgical management.

Materials and Methods: Patients with clinical stage I-III who received Neoadjuvant systemic therapy (NST) and underwent surgical intervention at Liaquat national hospital were included. The clinicopathologic factors included age, menopausal status, clinical tumor size, nodal status, stage, pathologic type, grade, molecular subtype, PR status, pathologic response, and treatment in terms of systemic therapy. The surgery underwent and pathologic stage(ypTN) were recorded. The association between these factors and PCR was analyzed with the chi-square test. Univariate analysis was performed to evaluate the influence of clinicopathologic factors on PCR.

Results: PCR was achieved in 174(19.6%) out of the 889 patients. There was a significant association (P-value <0.001) with molecular subtype as follows PCR percentage for HER 2 enriched-39% and luminal B HER 2 positive-31%, triple negative-25% ,Luminal A-6.5% and Luminal B-9.6%, progesterone receptors negative tumors (PCR-26.9%) and chemotherapy regime-Anthracycline and taxane PCR-28%. The predictive value of the three factors remains significant on univariate analysis. The breast conservative surgery rate was 34%, sentinel node biopsy was 60% and axillary PCR is seen in 20% of the patients (cN+ 60% to ypN+ 40%).

Conclusion: NST has a good overall impact in terms of achieving PCR and downsizing for breast-conserving surgery with better cosmetic outcome and de-escalation of axillary surgery. The positive predictive factors include molecular subtype, Her2 positive tumors being the most sensitive, progesterone receptor-negative tumors, and anthracycline and taxane-based chemotherapy.

Open Access Original Research Article

Psychosocial Impact and the Quality of Life of Patient with Acne Vulgaris among Public in Al Qunfudah Province, Southern Saudi Arabia

Safa J. Alamri, Motaz Dairi

Journal of Advances in Medicine and Medical Research, Page 22-33
DOI: 10.9734/jammr/2022/v34i331270

Background: Acne vulgaris is a common disease condition, affecting approximately 9.4% of the world's population, with the highest prevalence in adolescents. It affects over 90% of men and 80% of women in all ethnic groups. It is not life-threatening or physically debilitating; however, acne lesions can leave post-inflammatory hyperpigmentation and/or atrophic scars in moderate to severe acne cases, influencing quality of life (QoL) and leading to low self-esteem and weak social interactions.

Materials and Methods: This cross-sectional study was conducted in AlQunfudah, Saudi Arabia, in 2021. Data were collected using a Google form questionnaire. The study population consisted of 210 participants. Saudi women and men aged ≥15 years who agreed to participate in the study were included, and no exclusion criteria were used. We used the Dermatology Life Quality Index (DLQI), a validated questionnaire that grades QoL.

Results: The study included 210 patients with comparatively more women (83.6%) than men (16.2%). The age distribution showed that 48.1% (n=101) of the patients were 21-25 years old, and 21.9% were 26-30 years old. Patients with severe acne scars had a higher DLQI score (8.91 ± 5.56) compared to others (p<0.001), and those with grade III had high scores of 9.38 ± 5.14 (p=0.004). The DLQI scores were higher in individuals with post-acne hyperpigmentation. When we compared the skin type and grade of acne, it was found that more people with “oily skin” had grade III (18.8%) and grade IV (7.1%) acne compared to other skin types, whereas grade I was seen more in the dry (81.8%) and normal skin types (61.9%) (p<0.001). Similarly, severe acne scars were more common in grade III (45.5%) and moderate acne scars were more common in grade II (54.1%) than in other types (p<0.001). We observed that grade II acne displayed more post-acne hyperpigmentation (46.6%), whereas grade III had 14.3% and grade IV had 7.5%, which showed a statistically significant association (p<0.001).

Conclusion: Acne is a common skin disease in Al Qunfudah people and is a highly prevalent condition that affects both sexes. This has a considerable impact on their QoL. Health education is needed to encourage people to seek appropriate help.

Open Access Original Research Article

The Gender Associations of Neutrophil Lymphocyte Ratio in Acute Kidney Injury and Chronic Kidney Disease

Peter Kehinde Uduagbamen, Adesola T. Oyelese, Michael Gbenga Israel, Boladale Ajani Alalade, Sule I. Ahmed, Marion Itohan Ogunmola, Tolulope Esther Falana

Journal of Advances in Medicine and Medical Research, Page 45-56
DOI: 10.9734/jammr/2022/v34i331272

Introduction: The neutrophil lymphocyte ratio (NLR) is a cheap and readily available tool that is becoming increasingly recognized as a marker of pan-systemic inflammation. Gender differences have been identified in various inflammatory responses and play significant roles in the etiopathologic, epidemiological, clinical and prognostic profile of most disease entities. We assess gender association with the NLR.

Methods: One hundred and eighty eight participants (44 with acute kidney injury and I44 with chronic kidney disease were studied. Data on socio-demographics, clinical and laboratory findings such as NLR, serum electrolytes, albumin, uric acid and urine albumin creatinine ratio (UACR) were documented and gender associations of participants’ variables were determined.

Results: The NLR was higher in CKD than AKI, P=0.04, higher in females, P<0.001 and aged, P<0.001. The NLR was positively related to the platelet-lymphocyte ratio (PLR), albumin creatinine ratio, P=0.01 and the severity of the inflammatory condition. The men had higher serum albumin, creatinine, uric acid and UACR. The uric acid was higher in AKI than in CKD, P=0.04. The systolic blood pressure was higher in AKI than CKD, P<0.001. The serum bicarbonate was lower in AKI than CKD, P=0.04. In the elderly population, the proportion of females was more, P<0.001.

Female gender (OR-3.22, 95% CI-1.88-3.78), aging (OR-6.20, CI-3.17-9.58), smoking (OR-5.86, CI-4.52-8.95), elevated systolic blood pressure (OR-3.75, 95% CI-1.83-4.03) and elevated serum creatinine (OR-5.73, 95% CI-1.65-5.89) independently predicted elevated NLR.

Conclusion: The NLR is a readily available and cheap tool that was positively correlated with the age, BMI, blood pressure and inflammatory markers such as serum uric acid and UACR. It was higher in CKD than AKI, and in females. Being positively related to other inflammatory markers, it can be used in assessing the severity, prognosticating and perhaps predicting the outcome of inflammatory conditions.

Open Access Original Research Article

Prevalence of Acute Sars COV-2 Infection among Healthcare Workers and Their Associated Risk Factors in a Tertiary Care Centre of North India

Binish Gulzar, Farhana Anjum

Journal of Advances in Medicine and Medical Research, Page 57-68
DOI: 10.9734/jammr/2022/v34i331273

Background: Study on the SARS COV-2 and its associated risk factors among the Health care workers who are being in the frontline of the SARS COV-2 pandemic are facing a substantial risk of infection from Corona-virus disease 2019 outbreak.

Study: Hospital-based cross-sectional study.

Place of Study: Postgraduate Department of Microbiology, Government Medical College, Srinagar, Kashmir.

Duration: One year.

Methodologies: This is a hospital-based cross-sectional study design conducted in the Department of Microbiology, Covid Lab, where the participants were the HCW’s from GMC & associated hospitals along with many districts of Kashmir division suffering from acute respiratory infection suspected of COVID-19. All the participants provided information on demographic factors, medical history, and subsequently any COVID-19 symptoms along with the contact details before testing. And the test results for SARS-CoV-2 were obtained using real-time reverse transcription-polymerase chain reaction (rRT-PCR).

Results: Between March 2020 and March 2021, 7141 HCWs were tested for COVID-19 at Covid Lab, GMC Srinagar. A total of 913 (12.7%) HCW tested positive for Covid-19. Males 629 (68.8%) were affected more in comparison to females 284 (31.2%). The highest positivity was observed among the age group between 26-35 years of age 346 (37.8%) followed by 36-45 years 221 (24.2%). Among the positive 698(76.4%) were symptomatic. Doctors comprise a total of 533 (58.3%) of the total SARS COV-2 infected health care workers.

Conclusion: As apparent from the study, HCWs play a vital role in fighting the SARS-CoV-2  pandemic. The analysis along with the rapid and reliable access to testing of the infection status of HCWs is essential to preserve the health, safety, and availability of the healthcare workforce and to facilitate the rapid return of SARS- CoV-2 negative HCWs to work.

Open Access Original Research Article

Efficacy and Safety of Triamcinolone Injection in Keloid

Saly El-Said Ayad, Engi Saif Shaker, Naglaa Ibrahim Sarhan, Fatma Abd El-Ghaffar Abd rabo

Journal of Advances in Medicine and Medical Research, Page 69-75
DOI: 10.9734/jammr/2022/v34i331274

Background: A keloid scar is characterised by the production of type III (early) or type I (late) collagen. The goal of this study was to see how effective intralesional triamcinolone acetonide was in treating Keloids from a clinical and microscopic standpoint.

Methods: This prospective study included 40 patients diagnosed clinically and histologically with Keloid. Patients were given intralesional injection of triamcinolone (40mg / ml) and each 1 cm2 of keloid was injected by 0.3 ml of the solution for one session monthly for five subsequent sessions. Patients were subjected to full history taking, clinical examination [general and dermatological], digital photography of the lesions and tissue punch biopsies.

Results: Before treatment: Normal pigmentation occurred in 36(90.0%) and hyper pigmentation occurred in 4(10.0%). After treatment: Normal pigmentation occurred in 32(80.0%), hyper and hypo pigmentation occurred in 4(10.0%). Colour, itching, pliability and surface area were insignificantly different before and after treatment.

Conclusions: The triamcinolone injection was to be promising and long lasting for the suppression of symptoms related to keloids and hypertrophic scars.

Open Access Original Research Article

Computed Tomography Assessment of Nasal, Orbital Indices and Volume among Igbo, Calabari and Ogoni Residents of Portharcourt, Rivers State, Nigeria

Emmanuel Nebuwa Obikili, Salome Nwaelom Ezeofor, Godson Emeka Anyanwu, Eugene Clement Nzei

Journal of Advances in Medicine and Medical Research, Page 76-85
DOI: 10.9734/jammr/2022/v34i331275

Background: Understanding the morphology of the orbital and nasal cavities is essential for human identification, reconstructive surgeries and forensic medicine.

Objectives: To evaluate the orbital and nasal dimensions and their relationship with gender in the Igbo-, Calabari- and the Ogoni ethnic groups living in Port-harcourt Nigeria using computed tomography (CT).

Methods: Four hundred and sixty-six head CT images were analyzed. 43.8% were Igbos’, 28.8% Calabaris’ and 27.5% Ogonis’ of 20-80 years of age with a mean age of 51.19±15.67. Males and females were 55.8% and 44.2% respectively. Parameters measured were orbital height (OH), orbital width (OW), orbital depth (OD), nasal height (NH) and nasal width (NW) using the ImageJ software. Data analysis was by SPSS version 20. Differences between groups were obtained using the one-way ANOVA. P-value < 0.05 was considered statistically significant.

Results: Mean orbital volume for the Igbos’, Calabaris’ and Ogonis’ are 48.57±7.38, 48.97±5.63 and 46.27±5.59 for the right and 48.56±7.31, 48.96±5.62 and 46.32±5.56 for the left respectively P<0.05. Mean OD is highest in the Igbos’ 4.70±0.32 while mean OH is highest in the Calabaris 2.94±0.18 (P< 0.05). Igbos have the highest mean NI of 89.71. Males have higher NI P<0.05 in all ethinic groups. Mean OI shows no sexual dimorphism or unilaterality P>0.05

Conclusion: Differences in the measured parameters and sexual dimorphism in the nasal indices only among the ethnic groups is demonstrated.  Microseme and platyrrhine categories of orbital and nasal cavities respectively is similar to all. These findings will aid facial reconstructive surgeries and forensics.

Open Access Original Research Article

Laparoscopic Assessment of the Tubo Ovarian Relationship in Unexplained Infertility

Islam Mohammed Abdel Gawad Hadwa, Manal Abdel Raof Farahat, Abd Elghaffar Saeed Dawood, Lamiaa Mohammed Al Ahwal

Journal of Advances in Medicine and Medical Research, Page 86-98
DOI: 10.9734/jammr/2022/v34i331276

Background: Unexplained infertility is usually a diagnosis of exclusion. Thus, there must be an absence of an identifiable cause of infertility despite thorough testing and medical investigation demonstrating tubal patency, normal semen parameters, regular ovulation, normal ovarian reserve, and a normal endometrial cavity.

Aim: This study aims to assess the prevalence of abnormal tubo-ovarian relationship in women with unexplained infertility by using laparoscopy.

Methodology: This was a prospective study which was conducted on 30 couples with unexplained infertility. Evaluation of the tubo ovarian relation with laparoscopy for patient with unexplained infertility who desire spontaneous pregnancy. The main object of the corrective procedure is to get free mobile fallopian tube along with satisfactory tubo-ovaian relation.

Results: There were 53.3% of cases had disturbed tubo-ovarian relation, many corrective measures done by laparoscopy, such as adhesiolysis for 30% of cases, excision of cysts for 6.7% of cases, MSH for 16.6% of cases and cauterization of endometriotic patches for 16.6% of cases. In the present study a pregnancy rate of 53,3% (9/16) was seen in cases that showed disturbed tubo ovarian relation and required operative intervention higher than other cases with no detected pathology (4/14) 47.7%. We were able to achieve a higher conception rate among cases owing to operative procedure.

Conclusions: The ovum pick up by the fimbrial end of the tube is an essential determining factor for female infertility. The present study confirmed that laparoscopy provided a precise diagnosis of tubo ovarian factor and may switch the initial treatment of unexplained infertility.

Open Access Original Research Article

Giant Cell Arteritis: Does Perivascular Inflammation on Biopsy Lead to Clinical Disease?

Michael Macklin, Yousef Zarbalian, Li Wang, Ronald Hamilton, Kimberly Liang

Journal of Advances in Medicine and Medical Research, Page 108-116
DOI: 10.9734/jammr/2022/v34i331278

Background and Objective: Transmural inflammation of the temporal artery on biopsy is considered strongly suggestive of giant cell arteritis (GCA). Occasionally other inflammation patterns are seen. It is controversial whether these findings predict GCA-like disease. Our objective was to describe the clinicopathologic features in a cohort of patients with temporal artery biopsies to examine outcomes of patients with non-transmural inflammation.

Methods: We examined through retrospective chart review the clinical course from 2010-2020 of patients with temporal artery biopsies from 2010-2012. Biopsy results were divided into 3 groups: GCA transmural inflammation, non-GCA perivascular inflammation and negative. Non-GCA perivascular inflammation included small vessel, vasa vasorum and adventitial inflammation. Endpoints included constitutional and craniofacial symptoms, CRP and ESR levels, ASCVD, large vessel complications, and length of steroid treatment.

Results: 95 patients were included. Transmural patients had more visual loss compared with perivascular patients (55.5% vs 15.7%, p=0.004). Transmural patients had more jaw claudication or headache/jaw claudication compared with perivascular patients (44.5% vs 12.6%, p=0.01). Weight loss was more common in transmural patients compared with perivascular (27.8% vs 3.1%, p=0.02). Night sweats, PMR symptoms, and temporal artery tenderness were similar between groups. CRP was higher in transmural patients though not significantly. ESR levels were similar between groups. Transmural patients had a longer steroid duration with a median of 24 months vs 1.5 for perivascular, p=0.001.

Conclusion: Patients with non-transmural inflammation on temporal artery biopsies had improved outcomes when compared with transmural patients. This raises the question of whether steroids should be continued after a biopsy returns with perivascular inflammation.

Open Access Review Article

Reflection and Reflective Practice in General Practice: A Systematic Review Exploring and Evaluating Key Variables Influencing Reflective Practice

Akhigbe, Taiwo, Monday, Esther

Journal of Advances in Medicine and Medical Research, Page 34-44
DOI: 10.9734/jammr/2022/v34i331271

Background: Reflective practice is an essential part of general practice involving the trainee and the practitioners and the mechanism to promote this is the creation of portfolios to monitor evidence of reflective practices needed as part of licensing and revalidation in the United Kingdom

Aim: Evaluate the existing evidence about reflection and reflective practice models, utility, quality, significance, and implication for practice in General practice.

Methodology: Systematic databases search include Medline/PubMed, Embase, Cochrane CENTRAL, ERIC, and google scholar, limited to the last twenty years from January 2000 to January 2020.

Results: There were eight observational studies with 236 patients with over 90 percent of evidence that reflective practice is a tool for learning and development with poor evidence on the scale of measurement of reflective practice. No evidence for the effect of reflection on patient care. All evidence is level 2- with a grade C recommendation.

Conclusion: This systematic review of findings from eight studies of reflective practice in general practice. Relevant literature supports refection as a learning tool and process for mandatory assessment of performance and appraisal. In contrast, there is an overwhelming distaste for the current structure of e-portfolio for written reflection. There is no evidence for the effect of reflection on patient care and currently no standard scale of measurement to assess the quality of reflection in general practice.