Open Access Systematic Review Article

Is Intravenous Fluid Therapy Associated with Cerebral Oedema in Paediatric Diabetic Ketoacidosis? Literature Review and Critical Appraisal of Evidence

Akhigbe, Taiwo

Journal of Advances in Medicine and Medical Research, Page 57-63
DOI: 10.9734/jammr/2022/v34i431286

Objective: The ongoing controversy regarding fluid management in pediatric diabetic ketoacidosis (DKA) has necessitated this review of whether aggressive fluid therapy aggravates the risk of cerebral edema. The amount of fluid administered in pediatric DKA is estimated with a weight-based formula for correction of deficit, dehydration, and fluids maintenance. Cerebral edema is known to occur with hyperosmolar treatment or controlled hyperventilation treatment for cerebral edema.

Methods: A literature search was conducted using EMBASE, Medline, and Cochrane databases for systematic reviews and original articles published in the last 18 years from the year 2000 to 2018 using search words individually or in combination, Inclusion criteria were studies limited to pediatric patients treated for diabetic ketoacidosis. In addition, a critical appraisal of the most current evidence was performed.

Results: After the literature search, 913 articles were identified from Medline, Embase, and Cochrane databases. Non-relevant studies, non-full text studies, and studies that lacked control groups or articles that were duplicated were excluded leaving a final total of five full test articles for literature review and critical appraisal of evidence.

Conclusion: Almost all the studies showed that cerebral edema was associated with severe acidosis and prerenal azotemia in initial DKA presentation and only one case-control study showed a significant correlation with a higher volume of intravenous fluid therapy within the first three hours. The PECARN study put to rest age-long controversy and traditional teaching that aggressive fluid therapy in pediatric DKA may be responsible for cerebral edema with the conclusion that neither rate of fluid administration nor sodium chloride content significantly influenced neurological outcomes in Pediatric DKA

Open Access Systematic Review Article

The Influence of Finance on the Utilisation of Obstetric Services among Women in Rural Nigeria: A Systematic Review

Boma Iweriso George, Kinikanwo Innocent Green, Anthony Ike Wegbom

Journal of Advances in Medicine and Medical Research, Page 89-107
DOI: 10.9734/jammr/2022/v34i431290

Introduction: Nigeria has one of the highest maternal mortality rates in the world with greater concentration on rural areas. Underutilisation of obstetric is documented to be the major cause of the increasing high maternal mortality rate. Several factors are noted to influence rural women’s access to the use of obstetric services; however, finance appears to be the most important determinant. Hence, this review aims to explore the influences of finance on the utilisation of obstetric services among rural women in Nigeria.

Methods: We conducted a mixed method systematic review to identify the influence of finance on the utilization of obstetric services in rural Nigeria. Data were retrieved between January 2001 to July 2016 from CINAHL, MEDLINE, Academic Search Complete, ASSAI and ProQuest.

Results: Although, satisfaction with cost-of-service increases with the utilisation of obstetric services, it was not considered a hindrance to the utilisation of obstetric services. Poverty as a concept underpinned in finance was found to be the major reason women do not utilise obstetric services. However, most of the articles are not of high quality.

Conclusion: Finance influences the utilisation of obstetric services. Then, we recommend increased in empowerment of rural women to improve and secure its financial status. Furthermore, obstetric services should either be made free or at a very minimal cost, to increase obstetric service utilisation, hence reducing the high maternal morbidity and mortality.

Open Access Minireview Article

Role of Transforming Growth Factor-β in Epithelial-Mesenchymal Transition of Human Cancers - A Brief Review

P. Jayanthi, J. Selvaraj, R. J. Krishnasree, B. R. Varun, R. Rathy

Journal of Advances in Medicine and Medical Research, Page 74-82
DOI: 10.9734/jammr/2022/v34i431288

Epithelial Mesenchymal Transition (EMT) is a crucial process in embryogenesis, however it also plays an important role in pathologies including inflammation, wound healing and cancer. EMT is a determining step in cancer metastasis as tumour cells utilise the process of EMT for invasion, migration and colonization at distant sites. The transforming growth factor-β (TGF-β) is a pleiotropic inflammatory cytokine belonging to the TGF-β super family of growth and  differentiation factors secreted by immune, non-hematopoietic and tumour cells. Three TGF-β isoforms, TGF-β1, TGF-β2, and TGF-β3 are recognized in mammals. TGF-β induced signalling pathways remains the most prominent among other pathways inducing EMT. The TGF-β induced signaling pathways are inducted in all three types of EMT including the physiological embryogenesis process and pathological process such as wound healing and tumorogenesis. TGF-β acts via the SMAD and Non-SMAD pathways and plays major roles in tumour infiltration and metastasis. This article aims to briefly review the role of TGF- β induced signalling pathways and its role in tumour progression in human cancers such as lung cancer, breast cancer and oral squamous cell carcinoma.

Open Access Original Research Article

Effects of Maternal Thrombocytopenia on Pregnancy Outcome: A Prospective Observational Study

Saaliyah Khursheed, Duri Sameen, Deeba Farhat, Sheeraz A. Dar

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2022/v34i431279

Introduction: Platelets are non -nucleated cellular fragments of megakaryocytes, they play a critical role in haemostasis. Thrombocytopenia is a common medical disorder and is defined as platelet count less than 150,000/µl.

Objective: To study the aetiology of maternal thrombocytopenia and its effect on pregnancy outcomes.

Subjects and Methods: This prospective study was carried over a period of two years from July 2015-May2017 in SKIMS Medical College Bemina. Pregnant women with low platelet counts (count less than 150,000 /µl) in third trimester were taken as cases and rest served as controlled. All the thrombocytopenic cases were followed up throughout the antenatal period till delivery to record any complications that may develop due to low platelet counts. Platelet counts were repeated in the postpartum period at 1 & 6 weeks. Babies of all cases were tested for thrombocytopenia.

Results: The prevalence of thrombocytopenia in pregnant Kashmiri females was found to be 9.38%. Most cases were due to the condition labelled as gestational thrombocytopenia, the exact cause of which is unknown. It accounted for 60.2% of cases. Obstetric causes accounted for 23.2% of cases and medical causes accounted for 16% of cases. The incidence of postpartum haemorrhage in cases was 6.8% and in controls 2.4%, though the incidence is higher but statistically insignificant.

Conclusion: No significant increase in maternal complications and pregnancy seen with regards to thrombocytopenia.

Open Access Original Research Article

Evaluation of Solid and Liquid Medium for the Diagnosis of Mycobacterium Tuberculosis in Brochoalveolar Lavage Samples in a Tertiary Care Hospital in North India

Anjum Farhana, Danish Zahoor, Munazah Bhat, Farhat Kanth

Journal of Advances in Medicine and Medical Research, Page 8-13
DOI: 10.9734/jammr/2022/v34i431280

Aim: Tuberculosis is a global health problem. To control the disease, timely diagnosis is necessary. Both solid and liquid cultures have been used for diagnosis.  Brochoalveolar lavage is used as a specimen for diagnosis of smear negative tuberculosis and in patients who are   unable to expectorate sputum. The study was done to evaluate the performance for the detection of M. tuberculosis from BAL in terms of detection rates, time to positivity and contamination.

Study Design: This was a descriptive cross sectional study.

Methodology: BAL samples of suspected patients were collected in the Department of Microbiology, Government medical college, Srinagar. Samples were processed, decontaminated and subjected to smear microscopy by ZN staining, culture on solid (LJ) and liquid media (BacT Alert.).

Results: Out of 283 BAL specimens, 23 (8.13%) specimens were AFB smear positive and 260 (91.87%) were AFB smear negative.  The detection rate for Mycobacterium tuberculosis was 8.83% (25/283) on LJ and 12.37% (37/283) on BacT Alert. Overall, detection rate was comparable on smear positive samples but BacT Alert was more sensitive (7.7% detection rate) than LJ (3.46%) in smear-negative specimens. Although detection rates using BacT Alert were greater than LJ, 6 samples were positive exclusively on LJ medium. Time to positivity was significantly lower in liquid media but contamination rates were higher.

Conclusion: BacT/Alert affords rapid diagnosis of infection and therefore prompt institution of treatment for M. tuberculosis. Although BacT/Alert has higher sensitivity particularly in smear negative cases, there still remains a proportion of MTB specimens that may go undetected if not complemented with the solid media. Therefore it would be prudent if both the tests are used simultaneously to improve diagnostic yield.

Open Access Original Research Article

Obesity and Maternal Periodontal Disease do not Cause Changes in Offspring's Adult Life - Study in Rats

Thayná N. Petry De Paula, Sandra L. Balbo, Milara B. Moi, Valeria Suemi, João P. Paiva, Victor Miguel Goncalves Silva, Jakeline L. Teleken, Maria L. Bonfleur, Joao P. A. Amorim, Carlos A. Nassar

Journal of Advances in Medicine and Medical Research, Page 14-25
DOI: 10.9734/jammr/2022/v34i431281

Objective: To investigate the influence of MSG obesity and maternal periodontal disease on the mandibular bone loss of male offspring in adulthood.

Methods: 60 neonatal Wistar females were used and randomly separated into two groups. During the first 5 days of life, half of the female pups received subcutaneous injections in the cervical region of monosodium glutamate (MSG), and the other half-received of hyperosmotic saline solution (CTL). All animals used in the experiments received water and standard feed. At 70 days of life, animals were distributed into four experimental groups: control with no ligature (CTL NL), control with a ligature (CTL WL), MSG with no ligature (MSG NL), and MSG with a ligature (MSG WL). The four groups of females reproduced with control rats (2:1). Offspring (F1) were classified into 4 groups, according to the mothers' treatment.  Hemimandibles were collected for histological, morphological, and radiographic analysis and a portion of gingival tissue for analysis by enzyme-linked immunosorbent assay (ELISA) of cytokines IL-6, IL-10, IL-17, and TNF-alpha. Data were assessed using Two-way ANOVA and Tukey's test.

Results: There were no changes related to maternal hypothalamic obesity associated with periodontal disease in alveolar bone loss in the male offspring of F1 rats at 120 days.

Conclusions: Hypothalamic obesity and maternal periodontal disease did not affect the body and plasma parameters of their male offspring in the first generation, demonstrating that there was no effect of fetal programming on these parameters.

Open Access Original Research Article

Microbiological Profile and the Antimicrobial Susceptibility Pattern in Endotracheal tube tip Culture/ Endotracheal Aspirates of Mechanically Ventilated Patients at a Tertiary Care Hospital in Kashmir Valley: A Cross Sectional Study

Omar Rashid, Jalila Qayoom, Syed Khurshid, Rubhana Qadri

Journal of Advances in Medicine and Medical Research, Page 26-31
DOI: 10.9734/jammr/2022/v34i431282

Background: Respiratory infections are the leading causes of morbidity and mortality among mechanically ventilated patients. Early diagnosis and prompt institution of appropriate antibiotics play a pivotal role in the management, for which knowing the microbiological profile and the anti-microbial drug susceptibility pattern becomes inevitable. The current study was aimed to study the same.

Objectives: To determine the microbial etiology in endotracheal tip/tracheal aspirates of mechanically ventilated patients and study their antimicrobial resistance patterns.

Materials and Methods: A descriptive cross-sectional study was conducted in the department of microbiology, SKIMS, MCH BEMINA for 1 year. Endotracheal tube tip/ aspirate cultures of patients were processed by standard methods and their anti-microbial susceptibility patterns studied.

Results: Out of 63 samples, 53 (84.1%) were positive. Gram negative bacteria 42 (72.9%) were the predominant bacterial isolates. Acinetobacter showed resistance to all antibiotics barring Colistin, tigicycline and polymixin-b. While klebsiella was multidrug resistant, pseudomonas and E.coli were mostly sensitive.  MRSA showed high resistance except to vancomycin and linezolid.

Conclusions: Acinetobacter and klebsiella species were the predominant isolates with high resistance to most of the antibiotics.

Open Access Original Research Article

A Study of Adenosine Deaminase Activity and its Isoenzymes in COPD Patients with Acute Exacerbations

Heba Attia Mahmoud Khalil, Amira Yousef Ahmed, Ibrahim Salah El-din Ebrahim, Fawzy Abo El-Naga El-emery

Journal of Advances in Medicine and Medical Research, Page 32-38
DOI: 10.9734/jammr/2022/v34i431283

Background: The activity of adenosine deaminase decreases in COPD patients and the level of adenosine increases. Decreasing ADA activity in COPD patients can play a significant role in the formation of pulmonary injury.

Aim: The aim of this work was to evaluate the changes in serum total ADA level and its isoenzymes (ADA1 and ADA2) in COPD patients with acute exacerbations to determine the possible contribution of these enzymes in COPD.

Subjects and Methods: This study was carried out on 60 subjects at Chest Department, Tanta University Hospitals and were divided into three equal groups: group I included 20 healthy non-smokers subjects as control group, group II included 20 asymptomatic smokers and group III included 20 COPD patients with acute exacerbations.

Results: There was statistically significant decrease in the activity of ADA total and ADA isoenzyme (ADA1 and ADA2) in COPD patients compared with control group. A positive correlation between ventilatory functions of COPD patients and activity of ADA total and ADA isoenzyme.

Conclusion: These data are strongly suggestive of the role of adenosine deaminase activity and its isoenzymes in formation of pulmonary injury in COPD.

Open Access Original Research Article

The Effects of COVID-19 Pandemic on Family Planning Access and Use at Primary Health Centres in Rivers State, Nigeria

Kinikanwo I. Green, Clement K. Edet, Agiriye M. Harry, Mkpe Abbey, Ihuoma M. Opelia-Ezeh, Anthony I. Wegbom, Olatunde Raimi

Journal of Advances in Medicine and Medical Research, Page 39-48
DOI: 10.9734/jammr/2022/v34i431284

Introduction: The COVID-19 pandemic has posed challenges especially to health systems and population health. Many countries enforced border closures and implemented lockdowns which affected many sectors of the society. Increasing case load has led to many health authorities reassigning healthcare professionals and reorganizing existing health services to combat COVID-19 which may have affected routine and essential healthcare services, including family planning.

Aims: This study aimed to assess the impact of COVID-19 pandemic and restrictions on the access and use of family planning among clients in primary health facilities in Rivers State, Nigeria.

Study Design: Cross sectional survey.

Place and Duration of Study: Participants were recruited from eighteen primary health centres across six Local Government Areas (district) of Rivers State. Data was collected between 7th July and 9th August 2021.

Methodology: Women of reproductive age attending family planning clinic, antenatal sessions, post-natal clinic and immunizations sessions were interviewed using systematic random sampling. The questionnaire was adapted from the Research for Scalable Solution standardized questionnaire on family planning.

Results: A total of 759 women were interviewed and the mean age of participants was 32.19 (SD±7.49). 44.3% (n=314) of respondents had met need of family planning before the pandemic which increased to 64.8% (n=305) post-lockdown. Also, the unmet need for family planning was higher than the State average during the lockdown. 21.0% (n=50) had an unmet need for child birth spacing while 10.5% (n=25) had an unmet need for limiting. Furthermore, 34.2% (n=26) of respondents reported unintended pregnancies. Finally, there was a family planning method shift post-pandemic to long-acting reversible contraception being preferred.

Conclusion: The lockdown and restrictions had impacted the met and unmet need for family planning. Also, there was a method shift of family planning method seen. These findings can be taken into consideration in cases of future public health emergencies.

Open Access Original Research Article

Cancer Morbidity in Nigerian Females: The Need for a Grassroots Approach to its Prevention and Early Detection

Ikponmwosa Obahiagbon, Obiora Jude Uchendu

Journal of Advances in Medicine and Medical Research, Page 49-56
DOI: 10.9734/jammr/2022/v34i431285

Background: Cancer is increasingly becoming a major cause of morbidity and mortality, aggravated among women in developing countries because of increasing longevity, population growth and lack of capacity for treatment.

Aim: To highlight the cancer burden among Nigerian females and emphasize the need for a grassroots approach towards prevention and early detection.

Study design: This was a descriptive cross-sectional study.

Methodology: The study was retrospective, analysing data from histopathology reports of cases of cancer in females as diagnosed over 20 years (2000-2019) in the Department of Anatomical Pathology, University of Benin Teaching Hospital, Benin City, Nigeria.

Results: Over 56% of all cancers affected females with 64.9% of cases in the 4th-6th decades. Cancers of the breast, uterine cervix, colon and rectum, uterine corpus, ovary, haematopoietic and lymphoreticular system, and thyroid contributed 36.8%, 20.5%, 4.9%, 3.3%, 2.7%, 2.2% and 2.2% of cancers respectively.

Conclusion: Cancer among Nigerian females is increasing in incidence in the face of the existing weak treatment framework. There is urgent need to invest in cancer prevention and early detection strategies using grassroots-oriented and pre-existing structures to achieve a  reversal of this ugly trend.

Open Access Original Research Article

Mitigation of COVID-19 in Workplaces: When Push Comes to Shove in Offshore Oil Operation

K. A. Osakwe, O. Menkiti

Journal of Advances in Medicine and Medical Research, Page 64-73
DOI: 10.9734/jammr/2022/v34i431287

As COVID-19 pandemic is a novel disease with no prior antidote or proven preventive measures; global response in occupational settings significantly defaulted to remote working otherwise referred to as ‘Working from Home – WFH’ or ‘Remote Working’. While remote working favoured some industries and businesses, it was impractical for industries with processes requiring physical contact to operate such as in the offshore oil and gas industry. This meant workers in the offshore industry must dare the risk of exposure to access offshore work environment thereby increasing their exposure to the dreaded and incurable virus. The aim of this study was to explore and present effective response strategies to COVID-19 pandemic in offshore work environment when exposure becomes inevitable. The method adopted was an observational descriptive study (ODS) using the ad libitum sampling technique. A Walk-Through Survey (WTS) was conducted to observe and discuss the measures adopted by a representative offshore oil company in the Gulf of Guinea. The result showed significant potentials for increased transmission in the offshore oil industry. Multiple contact points and surfaces in offshore facilities, shared amenities and tools, and constrained proximity of working position constitute significant risk factors in offshore oil and gas facilities.  Mitigation measures could be categories as general measures; pre-embarkation strategies; transit strategies; aboard strategies; and remedial strategies. Combined measures have been found a workable and effective model to mitigate the spread and transmissibility; the eminence of distancing, serial testing, personal and community hygiene, and vaccination was established as a more effective model.

Open Access Original Research Article

Sciatica and Urinary Incontinence – Longitudinal for 12 Weeks Evidenced Research with Physiotherapy

S. S. Subramanian

Journal of Advances in Medicine and Medical Research, Page 83-88
DOI: 10.9734/jammr/2022/v34i431289

Low back ache (LBA) with sciatica can be associated with urinary incontinence among geriatric subjects while the patient was functionally rehabilitated in 12 weeks duration, nocturia persists various means of core strengthening exercises were adopted. Previous habits such as smoking, alcohol, ageing, sedentary life style, Benign prostate Hypertrophy (BPH), atrophy of pelvic floor could probably be the factors as evidenced. This research carries physiotherapist challenging role in a patient with LBA and urinary incontinence in one year regular physiotherapy care among a patient; outcome were discussed with due research support. Findings of this study with how much a subject can benefit having sciatica and urinary incontinence also points at where further studies can be continued.