Open Access Systematic Review Article

Anxiety and Coping with Anxiety in Patients with COVID-19: A Review of the Existing Literature

Taiwo Akhigbe

Journal of Advances in Medicine and Medical Research, Page 29-34
DOI: 10.9734/jammr/2022/v34i531294

Background: The outbreak of coronavirus disease 2019 (COVID-19) is associated with significant fear and extreme anxiety in patients; this can lead to a strong emotional state that can negatively impact their mental health and immune system. While the nature and effect of COVID-19 on mental health status are yet to be determined, existing literature offers some clues to understand what to expect in dealing with COVID-19 anxiety. The aim of this study is to evaluate the effects of anxiety and coping with anxiety in COVID-19 patients 

Method: This is a narrative review of existing literature relevant to the COVID-19 pandemic via PubMed, EMBASE, and GOOGLE SCHOLAR database on anxiety in patients with COVID- 19 and represented in a search flow. Articles search with the use of keywords in various permutations and combinations. 

Results: A total number of 73 articles were identified, following deduplication and exclusion of non-relevant studies two major articles, observational and randomized controlled trials were identified with broad themes specifically on the effect of anxiety on COVID-19 patients. These two publications were written in English and from Chinese centers. 

Conclusion: Current evidence revealed that increased social capital will improve sleep quality by reducing anxiety and stress of patients in self-isolation, also progressive muscle relaxation has a positive effect on improving sleep quality and reducing anxiety in patients with COVID-19. These findings have some serious clinical and public health implications hence this is a call for further research.

Open Access Systematic Review Article

Ivabradine-Management of Heart Failure (Systematic Review)

N. Rozman Antoliková, J. Pasztorova, J. Roháľová, A. Gažová, S. Valašková, B. Šalingová, J. Kyselovic

Journal of Advances in Medicine and Medical Research, Page 35-44
DOI: 10.9734/jammr/2022/v34i531295

Objectives: To assess the clinical effect of ivabradine on coronary artery disease and heart failure compared with placebo or standard care via clinical trials or meta-analysis.

Design: Systematic review and meta-analysis - searches of electronic databases from 2003 to 2018.

Data Extraction: Study results relating to benefit, risk and uses of ivabradine were extracted with individually meta-analysis or clinical trials.

Results: The primary analysis included 1413 records (keyword – ivabradine), of which 53 clinical studies were separated using the PRISMA-flow diagram with the following conclusion. The drug ivabradine has a positive effect on heart rate reduction in heart failure and other cardiovascular diseases. The health status of patients treated by ivabradine is generally better compared to patients with a placebo. Across the analysed trials, placebo, β-blockers, amlodipine or ranolazine were commonly used as control drugs in the control group. Ivabradine has been generally used as a replacement β-blockers in patients suffering from side effects. However, the effect of ivabradine is manifested only in patients with high heart rate (≥70/min.) and left ventricular dysfunction. We showed that ivabradine treatment is associated with an increased risk of the atrial fibrillation (AF), and the side effect is substantially more common than 1:10 000, presently reported in the product specification. This extent of AF incidence has not been previously reported in clinical trials.

Conclusion: Ivabradine treatment improved cardiopulmonary function and increased the exercise capacity patients with chronic heart failure. Ivabradine reduced mortality and hospitalization risk and improved the quality of life. Ivabradine appears to show better efficacy in comparison with β-blockers treatment, but this finding requires further study and clinical trials.

Open Access Case Study

Rhino-orbital-cerebral Mucormycosis during Pandemic of COVID-19: A First Case Reported in Libya

Mohamed Baayou, Eltaher Elshagmani, Fatma Emaetig, Mohamed Yousef Ben Sase, Hamasat Mustafa Ahmed, Fatma Ali Hamouda, Khaled S. Ben Salah

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2022/v34i531291

Mucormycosis is an unusual systemic infection caused by multicellular fungi. Despite,  few reports have been documented world widely, incidences of mucormycosis are recently increasing due to several predisposing factors such as diabetes, COVID-19 pandemic, and over prescription of corticosteroids. The clinical symptoms of this disease are often unfamiliar and vague. To the best of the authors’ knowledge, this is the first report that describes a case of clinical human mucormycosis during the COVID-19 pandemic in Libya. This report discusses also the risk factors and steps that can be applied to prevent occurrence of this disease. The patient is a 58-year-old Libyan female who presented with a history of COVID-19 infection, diabetes mellitus, hypertension, hypothyroidism, obesity, obstructive sleep apnea, and stable ischemic heart disease. She was complaining of loss of vision of the right eye, redness, and swelling all over the right face with scattered areas of blackish discoloration involving the inner third of the right eye and right face. Clinical examination showed bilateral basal and mid-lung fields fine crepitation, abdominal distension, severe chemosis, proptosis, restriction of all eye movement, aniscoria, upper lid ptosis and loss of corneal sensation of right eye. Computerized tomography (CT-Scan) of brain, para-nasal sinus, and orbit revealed right periorbital cellulitis, right eye proptosis, right ethmoidal, maxillary, sphenoidal sinusitis, and right cavernous sinus thrombosis without bone erosion. The histopathological report showed numerous broad branching aseptate hyphae and spores with acute cellulitis indicating an invasive fungal infection (mucormycosis). Mucormycosis is a rare fatal disease. Physician awareness and early management may significantly reduce mucormycosis severity.

Open Access Original Research Article

Hysterosalpingography Findings among Women Presenting for Infertility Evaluation in Bayelsa State, South-South Nigeria

E. K. Kiridi, P. C. Oriji, J. U. Ugwoegbu, I. J. Abasi

Journal of Advances in Medicine and Medical Research, Page 7-17
DOI: 10.9734/jammr/2022/v34i531292

Background: Hysterosalpingography is an investigative modality used in the evaluation of the uterine cavity, fallopian tubes, and adjacent peritoneal cavity following the injection of contrast material through the cervical canal.

Objective: To determine the pattern of pathologies seen in infertile women undergoing hysterosalpingography.

Materials and Methods: This prospective research was conducted at the Obstetrics and Gynaecology, and Radiology Departments of the two tertiary health institutions in Bayelsa State, Nigeria, from January to July, 2021. Hysterosalpingography was done for 350 infertile women, after obtaining written informed consent. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions (SPSS) version 25.0. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables.

Results: The most common tubal finding was blockage; 7 in 10 (71.7%) women had at least one blocked tube. One hundred and nine (31.1%) had both tubes blocked, the left tube was blocked in seventy-nine (22.6%), while the right tube was affected in sixty-three (18.0%) women. Hydrosalpinx affected the right, left and both tubes in 20 (5.7%), 8 (2.3%) and 4 (1.1%) women respectively. Uterine findings were fibroids (21.1%), intrauterine adhesion (3.4%) bicornuate uterus (0.9%) and adenomyosis (1.1%).

Conclusion: This study revealed a high incidence of tubal blockage in the women being evaluated for infertility. The plausible reason for this observation may be due to post-abortion sepsis and pelvic inflammatory disease that may have arisen from induced abortion, as observed in our study. Hysterosalpingography remains a very crucial investigative modality that plays a central role in the evaluation of infertile women.

Open Access Original Research Article

Expression of CD127 Suppresses T Regulatory Cells in Psoriasis

Shirin Tarafder, Sabia S. Sultana

Journal of Advances in Medicine and Medical Research, Page 18-28
DOI: 10.9734/jammr/2022/v34i531293

Background: Psoriasis is a genetically regulated autoimmune skin disease associated with the impaired suppressive function of Treg cells. Foxp3 is the accepted marker of Treg cell, but CD127 (IL-7Rα), a surface marker of activated T cell, can distinguish the functional status of CD4+CD25+FoxP3+Treg cells. The study aimed to demonstrate the functional status of Treg cells in peripheral blood of psoriasis patients, to analyze their association with disease severity and duration, serum IL-17 level, and IL-23R gene polymorphism to observe the relationship with susceptibility to psoriasis.

Methods: Thirty-five psoriasis patients and 35 healthy controls were enrolled. Demographical details were recorded, severity was assessed by Psoriasis Area and Severity Index (PASI) scoring. Treg cells were quantified by flowcytometric immunophenotyping, serum IL-17 level by ELISA, and IL-23R gene polymorphism by Real-Time PCR.

Results: Increased circulatory CD4+CD25+FoxP3+Treg and CD4+CD25+FoxP3+CD127+/pTreg cells observed in psoriatics than in controls (P<0.05) but CD4+CD25+FoxP3+CD127-/tTreg cells significantly decreased (P<0.001). IL-17 levels were elevated in psoriatics (P=0.002). In severe patients, FoxP3 expression decreases in tTreg cells and are CD127+. Out of 35 patients, 23 (65.71%) had an AA genotype of IL23Rrs10889677 gene polymorphism, associated with increased Treg, tTreg, pTreg cells, and IL-17 levels revealed susceptibility to psoriasis.

Conclusion: This study shows the loss of tTreg function and pTreg cell activation in psoriasis, supporting the autoimmune disease model. CD127 expression can better distinguish Treg cells and augmenting the CD127-/low population of Treg cells to restore suppressive activity by anti-CD127 mAb therapy can be a potential treatment option for psoriasis patients.

Open Access Original Research Article

Role of Point of Care Ultrasound in Confirmation of Endotracheal Tube Placement in Children

Fekry Roshdy Mohamed, Mohamed Gamal el-bahnasawy, Mohamed Hasan El-shafey, Mohamed Samy Sharaf

Journal of Advances in Medicine and Medical Research, Page 45-51
DOI: 10.9734/jammr/2022/v34i531298

Background: In the emergency department (ED), During airway management, tracheal intubation (TI) is a routine procedure in neonatal and pediatric critical care units, as well as the delivery room. The location of the endotracheal tube (ETT) should be confirmed as soon as possible since tube malposition is linked to severe complications such as aspiration, air leak syndromes, and oesophageal intubation. In perioperative, emergency, and critical care settings, ultrasound (US) gives point-of-care dynamic images of the airway.

Objective: The goal of this study is to evaluate the results of utilizing Trans-tracheal POCUS to confirm ETT implantation with other confirmatory procedures including colorimetric capnography and direct viewing.

Methods: The study was done at Al-Azhar & Tanta University Emergency Hospital and was a prospective observational study. To locate the tube, we employed tracheal sonography and an ETCO2 analyzer for capnography. We evaluated the amount of time required and the accuracy of the findings.

Results: There were a total of 40 children that required emergency endotracheal intubation. Endotracheal ETT was found in 37 (92.5%) of the patients, while esophageal ETT was seen in three (7.5%) patients. The capnography was the standard for detecting the ETT placement correctly. In 97 percent of patients, ultrasound was able to identify all esophageal intubation and confirm the insertion of an endotracheal tube (ETT) with a sensitivity of 100 percent and a specificity of 97.5 percent. The clinical assessment had misunderstood 16.2 percent of tracheal intubations and 2 out of 3 esophageal intubations.

Conclusion: POCUS is considered an accurate method in endotracheal tube insertion confirmation, resulting in safe, fast, and reliable airway management approaches.

Open Access Original Research Article

Prevalence and Causes of Blindness and Visual Impairment in Awka, South-East Nigeria: A Tertiary Hospital Study

A. C. Udeaja, B. C. Ochiogu, C. C. Uzozie

Journal of Advances in Medicine and Medical Research, Page 52-59
DOI: 10.9734/jammr/2022/v34i531299

Background: 10 years prior to this study period (2017) the Nigerian National Blindness and Visual Impairment Survey (2007) obtained data from all states and regions of Nigeria to enable for effective planning and provision of eye care. 10 years later on update of the statistics is most desirable especially with local studies. This is a preliminary study and the data obtained will act as template for effective formulation/planning on management of visual impairment and blinding ocular problems.

Objective:  i. To determine the prevalence and causes of blindness and visual impairment in Awka, South East Nigeria. ii. To provide data-base for effective eye care delivery.

Methodology: A retrospective, hospital-based study of new patients seen over a 12 months period from January to December 2017 at the Eye Clinic Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka.

Result: A total of 1,776 patients were seen in the 12 months period. 737 (41.5%) were males, and 1039 (58.5%) females with ratio of 1:1.4 respectively. The most frequently occurring age group was 21-30 years, followed by 11-20 years. Out of the patients reviewed 185 (10.4%) had visual impairment (presenting VA  6/18) in at least one eye. 72(4.1%) had blindness (presenting VA<3/60) in at least one eye. 113(6.4%) had low vision or moderate and severe visual impairment (MSVI) (presenting VA  6/18 to 3/60) in at least one eye. 59 patients (3.3%) had visual impairment in both eyes. 16 (0.9%) were blind in both eyes whilst 43 (2.4%) had low vision in both eyes. The prevalence of blindness, low vision and visual impairment was 0.9%, 2.4%, 3.3% respectively. Major causes of blindness were Glaucoma (26%), Cataract (23.3%), Trauma (13.3%). For visual impairment it was cataract (24%) glaucoma (22%) and refractive Error (21.2%).

Conclusion: The common causes of blindness are avoidable. More robust eye care systems involving promotion, preventive and curative measures should be developed to address the identified common causes of blindness and visual impairment.

Open Access Original Research Article

The Metabolic Syndrome in Rheumatoid Arthritis - A Observational Study

Abhishek Nigam, Prakash Joshi

Journal of Advances in Medicine and Medical Research, Page 60-67
DOI: 10.9734/jammr/2022/v34i531300

Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affects mainly the small joints of the hands and feet, it has both articular manifestations and extra articular manifestations. The joints commonly involved in Rheumatoid arthritis are the wrists, small joints of the hands and feet, i.e the metacarpophalangeal (MCP) joints, interphalangeal joints of the thumbs, proximal interphalangeal (PIP) joints of the fingers and metatarsal phalangeal (MTP) joints. Distinctively the distal interphalangeal (DIP) joints are spared. Extra Articular manifestations of Rheumatoid Arthritis are seen in up to fifty percent of patients. Extra articular manifestations are in the form of episcleritis, skin ulcers, scleritis, rheumatoid nodules, neuropathy, pleural involvement, interstitial lung disease, pericarditis, myocarditis, coronary artery disease (CAD), glomerulonephritis, sicca symptoms, vasculitis and atherosclerotic disease. Aim: To Study The Metabolic Syndrome In Rheumatoid Arthritis Patients. Objectives: To Study Metabolic Syndrome in Patients with Rheumatoid Arthritis. To Study the Relationship between Metabolic Syndrome and Disease Activity. Hence it can be concluded that the prevalence of Met S was high in patients of Rheumatoid arthritis. The levels of triglycerides, fasting blood sugar, blood pressure, waist circumference was higher in study subjects having Met S while the HDL level was lower than patients not having metabolic syndrome. This difference was found to be significant statistically. Therefore, it is essential to manage Met S for prevention of CVD in patients of rheumatoid arthritis.

Open Access Original Research Article

OCT Macular Changes in Amblyopic Children

Bola George Abdelmeseh, Heba Mohamed Shafik, Elsayed Samir Arafa, Ahmed Lotfi Ali

Journal of Advances in Medicine and Medical Research, Page 68-74
DOI: 10.9734/jammr/2022/v34i531302

Background: Amblyopia is defined as a decrease in best-corrected visual acuity in one or both eyes that is not solely due to a defect in the structure of the eye. This study aimed to investigate the OCT changes occurring in the amblyopic eye retina compared to normal eye.

Methods: This prospective study was carried out on 30 cases diagnosed with amblyopia using the better eye as a control. Patients were subjected to Assessment (visual acuity was measured by Landolt’s chart. Refraction error measured by autorefractometer) and macular analysis.

Results: CMT was statistically insignificant difference between amblyopic and non-amblyopic eyes. The difference in AMT between amblyopic and non-amblyopic eyes was statistically significant (p = 0.001).  BCVA in different ages before and after treatment was statistically significant difference (P=0.001). The various types of refractive errors of the studied eyes regarding BCVA, before and after treatment was statistically significant difference (P=0.001).

Conclusions: CMT and AMT of the amblyopic eye more than the sound eye and after 6 months of patching, there was a decrease in the CMT and AMT of the amblyopic eye.

Open Access Original Research Article

Ultrasonographic Assessment of Third Trimester Fetal Kidney Length as a Measure of Gestational age in Growth Restricted Fetuses

Nadra Elsaid Mohamed Eldafrawy, Naglaa Ali Mohamed Hussein, Amr Mohamed Tawfek Elbadry, Nagwa Ibrahim Mohamed AgIlan

Journal of Advances in Medicine and Medical Research, Page 75-89
DOI: 10.9734/jammr/2022/v34i531303

Background: Obstetric ultrasound is the first imaging modality used to assess the foetus and track its development. When the last menstrual period (LMP) is unknown, foetal ultrasonography can help with dates. According to studies, over 30% of pregnant women forget their LMP date. When the gestational age (GA) is uncertain, the pregnancy's outcome may be undesirable. To assess the ultrasonographic fetal kidney length as a measure of gestational age in third trimester.

Methods: All participant women were in the third trimester whose gestational age was calculated by reliable LMP which was confirmed by recorded ultrasonic measurement of BPD, AC& FL).

Participant women were divided into 2 equal groups:

Group 1: normal pregnancy & average.

Group 2: patients with growth restriction fetuses.

Results: The mean length and width of the left kidney were similar in both groups, as the mean length of the left kidney in the IUGR group was (38.40 ± 4.000) while it was in the control group (38.17 ± 3.637). The average width of the left kidney in the intrauterine growth restriction group was (23.09 ± 2.339) while it was in the control group (23.16 ± 2.341), there were significant positive correlations between the different study variables. A positive association was found between gestational age, fetal weight, bipolar diameter, femur length and abdominal circumference with the length of the right kidney, and they also found a positive association with the length of the left kidney.

Conclusions: In absence of renal anomalies/ abnormalities, kidney measurements; length, weight, volume can be used to determine gestational age accurately.

No difference between measuring Rt or Lt kidney on determining GA. Also, no difference between measurements in female or male fetuses.

Kidney measurement is not affected in cases of IUGR and can be used as a reliable indicator for actual gestational age of the fetus in these cases.

Open Access Original Research Article

Cerebral Palsy among Children Seen in University of Port Harcourt Teaching Hospital: Aetiologies and Comorbidities

N. Gabriel-Job, A. I. Frank-Briggs, S. Douglas

Journal of Advances in Medicine and Medical Research, Page 90-96
DOI: 10.9734/jammr/2022/v34i531304

Introduction: Cerebral palsy (CP) is a common neurologic disorder, particularly in the developing countries where the aetiological factors are preventable. The aim of this study is to determine the pattern of Cerebral palsy among children in Port Harcourt.

Methods: A one year retrospective descriptive study of patients seen in the Paediatrics Neurology clinic with a diagnosis of Cerebral palsy was done. Demographics, medical history, examination and investigation findings were obtained from the Patients’ medical records.

Results: A total of 111 children with CP were seen in the clinic from 2020 – 2021. There were 75 (67.6%) males and 36 (32.4%) females giving a male to female ratio of 2:1. Their ages ranged from 6 months to 12 years with a mean age of 3.4 ± 1.9 years at presentation. Birth asphyxia 56(50.1%), bilirubin encephalopathy 22(19.8%) and neonatal infections 8 (7.2%) were the leading cause of CP. The commonest subtype of CP was spastic quadriplegia in 68 (61.3%) of them. Microcephaly (26.7%), seizure disorder (24%) and speech impairment (16.0%) were the commonest observed comorbidities.

Conclusion: CP is still prevalent in Port Harcourt. Preventable causes remain the leading culprit. Modalities to prevent birth asphyxia and bilirubin encephalopathy in our community will reduce the incidence of CP.

Open Access Original Research Article

Maternal Mid-Trimester Placental Growth Factor and Uterine Artery Doppler Velocimetry in Evolution of Pre-Eclampsia

Sara Abdelrahman Nour, Ahmed Mahmoud Hagras, Hesham Ahmed ELserogy, Ahmed Hussein Abou Freikha

Journal of Advances in Medicine and Medical Research, Page 97-110
DOI: 10.9734/jammr/2022/v34i531305

Background: Early detection of pre-eclampsia (PE) has become one of the fundamental goals of perinatal medicine. Although clinical symptoms of PE emerge after the 20th week of gestation, trophoblast invasion that is responsible for pathogenesis occurs in the first trimester. This study aimed to evaluate the clinical utility of the Placental Growth Factor and uterine artery Doppler velocimetry in the evolution of preeclampsia.

Methods: This was a cohort prospective study that was carried out on sixty pregnant women who were classified into 3 equal groups of pregnant women who had gestational age ranging from 20 to 26 weeks: the first group included pregnant women with normal pregnancy, the second group included pregnant women with mild preeclampsia, and the third group included cases with severe preeclampsia.

Results: The mean of gestational age at delivery was significantly lower in patients who had severe preeclampsia than those with mild preeclampsia and controls. In contrast, there was no significant difference in the mean gestational age at delivery of patients with mild preeclampsia and controls. As for serum glutamic-oxaloacetic transaminase (SGOT), the concentration increased significantly in cases with severe preeclampsia compared to that of mild preeclampsia and controls. However, there were non-significance differences between controls and cases with mild preeclampsia. Receiver Operating Characteristic (ROC) curve showed that perfusion index (PI) had significantly higher diagnostic accuracy than other indices in predicting the outcome of the pregnancy and uterine artery pulsatility index had significantly higher diagnostic accuracy than both placental growth factor (PlGF) and uterine artery resistance index in predicting the severity of preeclampsia.

Conclusions: Uterine artery Doppler screening is simple and non-invasive and there is a clear association of elevated mean uterine artery PI, respiratory index (RI), and also serum PlGF in the second trimester, with the occurrence of PE. Uterine artery pulsatility index (UAPI) was significantly associated with a high incidence of PE. The sensitivity or prediction is increased by adding serum marker PlGF and combinations provide an increase in the ability of prediction and determination compared to the tests used alone.