Open Access Case Report

18F-FES PET-CT Scan in Patients of Histopathologically Proven Estrogen Receptor Positive Breast Carcinoma at a Tertiary Care Facility

Sadia Adnan, Muhammad Numair Younis, Tahira Yasmin, Arzoo Fatima, Irfan Ullah Khan, Misbah Masood, Abubaker Shahid

Journal of Advances in Medicine and Medical Research, Page 54-59
DOI: 10.9734/jammr/2022/v34i631313

Aims: To ascertain successful labeling and image performance of 18F-FES PET-CT scan in patients who have histopathologically diagnosed estrogen positive breast cancer.

Study Design: Histopathologically proven estrogen receptor positive patients were enrolled for 18F-FES PET-CT scan.

Place and Duration of Study: Department of Nuclear Medicine, Department of Radiopharmacy and Department of Oncology, Institute of Nuclear Medicine and Oncology Lahore- INMOL. Duration of the study including planning phase and performance of imaging was 6 weeks spanning between July till Aug 2021.

Methodology: 18F-FES was produced by direct nucleophilic radio-fluorination of 3-O-methoxymethyl-16,17 O sulfuryl-16-epiestriol followed by acidic hydrolysis at INMOL. After quality control tests, 18F-FES was injected to the patients. At 60 minutes post injection, each patient underwent PET-CT imaging in supine position as per standard protocol given in the published literature. Image interpretation and processing was performed.

Results: Study was performed on 2 patients. The first patient had estrogen receptor positive breast tumour on trucut biopsy and the second patient presented after excision biopsy. The second patient demonstrated skeletal, nodal and pulmonary metastases.18F-FES uptake was observed in the primary tumour as well as in all metastatic sites.

Conclusion: 18F-FES can successfully be labeled and 18-FES PET-CT can be performed in estrogen receptor positive breast cancer patients to take appropriate treatment decisions.

Open Access Case Study

A Mass Occupied in Neck Carotid Bifurcation Territory Diagnosed Sebaceous Adenocarcinoma: A Case Report

Donghui Jiang, Xiaoguang Wu, Yanxuan Jia, Shilin Ni, Xiaoguang He

Journal of Advances in Medicine and Medical Research, Page 49-53
DOI: 10.9734/jammr/2022/v34i631312

Aims: To describe a rare case presenting with pulsing mass stumbled across the right upper neck.

Presentation of Case: The patient was presented to the outpatient department of ENT due to a pulsing mass stumbled across the right upper neck for half a year. Cervical enhancement CT scan was performed, which disclosed a lesion at the bifurcation of the right carotid artery and possessed insignificant blood supply. Hospitalization was arranged for a full examination, and culminating in a diagnostic resection.

Discussion: This case was challenging for clinicians to differentially diagnose the placeholder at the carotid artery bifurcation, and the pathological results in this case was extremely rare and have never been reported in the literature. Extraocular SGC is strongly associated with Muir–Torre syndrome (MTS), a phenotypic variant of Lynch syndrome and results from mutations in DNA MMR genes. It suggests all patients presenting with sebaceous neoplasms should be screened for MTS.

Conclusion: Our case creates a paradigm for otolaryngologists and oral and maxillofacial surgeons.

Open Access Original Research Article

Effect of Omega-3 Supplement on Oxidative Stress Markers in Brain and Heart Tissue Homogenates of Shock Induced Albino Rats

Umezulike, Liousa Njogo, Waribo, Helen Anthony, Onwuli, Donatus

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2022/v34i631306

The study evaluates the effect of omega-3 supplement on oxidative stress markers in the brain and heart homogenates in male albino rats induced with shock stress using the electroconvulsive device. 25 rats weighing averagely 110g were divided into 5 groups of five rats each with different treatment regimens. Group I served as the negative control, Group II as shock control, Group III as omega-3 control, Group IV given omega-3 supplement by oral gavage method daily for the first one week and induced stress by shock for 5 days, Group V was induced stress by shock for 5 days and then administered omega-3 supplement for one week. 1 ml Omega-3 supplement equivalent to 123mg/kg body weight was given to the rats through oral gavage method. The results shows that omega-3 supplement significantly increased (P< 0.05) the superoxide dismutase, catalase and glutathione values while the malonaldehyde and nitric oxide values were reduced after being exposed to shock stress, then pretreatment and post treatment with omega 3 supplement in both the brain and heart tissues of the albino rats when compared to the shock control group whose values were reduced except for the value of malonaldehyde and nitric oxide which was increased. Oxidative stress is implicated in the brain homogenates than in the heart of the albino rats induced with shock stress. The study reveals that Omega-3 supplementation shows more effective protection for these organs notwithstanding the time of administration though pretreatment with omega 3 supplement shows more ameliorating effect than the post treatment. Hence intake of omega 3 might protect our organs against oxidative induced stress.

Open Access Original Research Article

Study of Soluble CD52 as a Tumor Marker and Indicator of Disease Activity in Chronic Lymphocytic Leukemia

Fatma ElSaid Swadan, Hesham Ahmed Elserogy, Mohamed Attia Saad Attiaa, Hussam ElDin Ahmed ElAshtokhy

Journal of Advances in Medicine and Medical Research, Page 19-27
DOI: 10.9734/jammr/2022/v34i631308

Background: Chronic Lymphocytic Leukemia (CLL) is non-curable disease and has variable course among patients. In some patients it progresses fast despite sever treatment and is fatal within 2 to 3 years whereas others require no or minimal treatment and die due to cause other than CLL. The aim of this work was to investigate the circulating soluble CD52 in blood of CLL patients to explore its usefulness as diagnostic and prognostic biomarker.

Methods: This study included 40 cases who were divided into four equal groups; group 1 was patients who were newly diagnosed with CLL, group 2 was cases of chronic lymphocytic leukaemia with complete remission after treatment, group 3 was cases of relapsed chronic lymphocytic leukaemia and group 4 was the control group. All patients were subjected to clinical examinations ,laboratory investigations including: (complete blood counting, liver function tests, kidney function test, LDH Immunophenotyping) and specific laboratory investigation of soluble CD52 using ELISA.

Results: ROC curve for SCD52 to discriminate between newly diagnosed cases and control group with cut of point 201(ng / ml) and AUC 0.890 with p value 0.003 with sensitivity and specificity 80% and to discriminate between relapsed cases from complete remission cases with cutoff point 345 (ng / ml) and AUC 0.840 with (p value 0.010) with sensitivity 80% and specificity 90%. In group 1and group 3, there were positive correlation between SCD52 and staging system,  absolute lymphocytic count and LDH, significant negative correlation between SCD52 and platelet count.

Conclusions: The role ofsCD52 as diagnostic and prognostic marker for CLL due to its relation to CLL disease activity.

Open Access Original Research Article

Recent Fecal Biomarker for Inflammatory Bowel Disease, Neutrophil Gelatinase Associated Lipocalin

Mona Sayed Ahmed Dawood, Nashwa Mohammed Abo Elnasr, Sherif Elsayed Ezzat, Gihan Farouk Attia, Mohamed Mokhtar Mabrouk

Journal of Advances in Medicine and Medical Research, Page 28-35
DOI: 10.9734/jammr/2022/v34i631309

Background: In the field of IBD many biomarkers have been studied to find the ideal noninvasive biomarker that best correlates with disease severity and prognosis.

NGAL is a biomarker that have been studied and measured either in serum or fecal in different pathological conditions such as AKI, IBD and autoimmune disorders.

In our study we aim to evaluate the accuracy of fecal NGAL levels in correlation with endoscopic scoring, and common serum inflammatory markers in patients with IBD.

Methods: In this randomized prospective controlled study Fecal NGAL levels were measured using the Elisa technique in 30 patients with ulcerative colitis 10 patients with Crohn’s disease and 20 healthy controls. The results were correlated to colonoscopic severity index and commonly used serum inflammatory markers (highly sensitive CRP, ESR, white blood cell count).

Results: Fecal NGAL levels (median and interquartile range) were significantly elevated in patients with active ulcerative colitis (UC) 6.05 (3.6–15.1) mg/kg and Crohn’s disease (CD) 4.9 (1.5– 7.7) mg/kg, compared to healthy controls (HC) 0.3 (0.1–0.4) mg/kg. Sensitivity and specificity were 94.7% and 95.7%, respectively, for distinguishing between active IBD and HC.

Conclusions: Fecal NGAL is a noninvasive biomarker that strongly correlate to different parameters of the disease activity in IBD patients. Because most biomarkers are only found in granulocytes, NGAL's epithelial localization could provide additional diagnostic information.

Open Access Original Research Article

Compliance with WHO Recommended Preventive Measures against COVID-19 among a Nigerian Population Attending a Teaching Hospital

Soroye, Modupeoluwa Omotunde, Onigbinde, Olubunmi Omotunde, Aikins, Elfleda Angelina

Journal of Advances in Medicine and Medical Research, Page 36-48
DOI: 10.9734/jammr/2022/v34i631310

Background: The fright and devastation that accompanied COVID-19 pandemic these past two years cannot be totally quantified. More so, the cycle of fear, panic, uncertainty and attempts at curtailment repeats itself every time the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mutates and produces a new variant. The World Health Organization recommended personal protective measures are very important in slowing down the spread of infection. This study assessed the compliance of a Nigerian population with protective measures recommended by WHO in curbing the spread of COVID-19 infection.

Materials and Methods: A cross-sectional survey among patients attending medical outpatient in a Teaching Hospital. Interviewer administered questionnaire was used to collect data on participants demographics and compliance with WHO recommended preventive measures towards prevention of COVID-19 infection. Data analysis was carried out with Statistical Package for Social Science (SPSS) version 25(IBM Corp., Armonk, USA).  The results were presented as frequency tables and cross-tabulations. Chi-square test was carried out with consideration for statistical significance at       P<0.05.  

Results: One hundred and ninety-six consecutive participants who gave consent were recruited for the study. There was a male predominance. Participants’ age ranged between 18 and 84 years with mean age of 34.92±14.10 years. Median age was 30 years. Half of participants had university education and about one tenth are professionals. About two-fifth earned less than 100 dollars monthly. Though about three-fifth of participants have heard of WHO recommended hand washing techniques for COVID-19 prevention, only two-fifth practice it. One third of participants regularly use face mask in the public and 85.2% do not practice physical distancing. Less than 10 % do not use soap and water or sanitizer to clean their hands. . The participants’ attitudinal change to handwashing as a preventive measure for COVID-19 prevention was good. Participants’ most practiced personal preventive measures against COVID-19 were regular washing of hands and boosting immunity with vitamins. The association between participants’ demographics and WHO recommendation for hand washing in the prevention of COVID-19 showed a significant based on sex (p= 0.04). Females paid attention to washing of hands than males. The association between participants’ demographics and use of face masks in the prevention of COVID-19 showed that education was significant in determining use (P=0.04)

Conclusion: Awareness of personal preventive measures to COVID-19 washing of hands was increased among participants but there is the need to emphasize the wearing of face masks and physical distancing.

Open Access Original Research Article

Marital Status and Level of Depression and Anxiety

Danielius Serapinas, Andrius Narbekovas

Journal of Advances in Medicine and Medical Research, Page 60-66
DOI: 10.9734/jammr/2022/v34i631314

Backround: Romantic relationships were described as the unique partnership where intimacy and mutual feelings of love and affection are manifested. However they may be linked with some level of anxiety and depression - two separate conditions, that strongly linked to one another with almost indistinguishable elements. The aim of the study to analyse the link between romantic relationships and depression & anxiety.

Methods: A total of 120 participants currently engaged in a dating romantic relationship (80) and  marriage (40), specifically targeting young adults aged between 18-35 (M = 24.79 years) have filled questionaires.Main instruments that were used in this paper were: Rubin's Love Scale, PHQ-9) and Zung’s anxiety scale.

Results: Results supported findings from previous research that are conducted in this field. While depression and anxiety levels are positively linked, participants who answered the questionnaire showed that when the love in the romantic relationship is high, anxiety and depression symptoms seemed to be decreased. Married individuals are more likely to have a high score of love and less score on depression & anxiety compared to individuals who are engaged in a dating relationship.

Conclusions: Romantic or - better described- companionate love component of the relationships are linked with fewer symptoms of anxiety and depression. Married individuals had a higher score of romantic love, and fewer symptoms of depression anxiety, compared with the ones who were in a committed relationship.

Open Access Original Research Article

Comparative Study of Patients Outcomes by Using Dexmedetomidine with Bupivacaine Versus Bupivacaine Alone in Ultrasound-Guided Thoracolumbar Interfacial Plane Block for Spine Surgeries

Mohamed Zakarea Wfa, Ahmed Saeid Ahmed El-Gebaly, Ghada Fouad El-Baradey, Kamal El-din Ali Mohamed Hekal, Jehan Mohamed Ezzat Darwish

Journal of Advances in Medicine and Medical Research, Page 67-77
DOI: 10.9734/jammr/2022/v34i631315

Background: Thoracolumbar interfacial plane block (TLIP) is effective and safe method used with general anesthesia to achieve the optimum analgesia. This study evaluates theanalgesic effect, hemodynamic changes, consumption of inhalational anesthesia and stress response by measuring cortisol level when adding dexmedetomidine to bupivacaine in the ultrasound-guided thoracolumbar interfacial plane block in spine surgeries (lumber and lower thoracic T11-T12).

Patients and Methods: sixty adult patients of both sexes aged (21-60) years with ASA physical status I/II scheduled for elective spine surgeries (laminectomy and spinal fixation) at the level of lower thoracic (T11-T12) and lumber vertebra. Patients divided into two groups, group A of thirty patients were given 20 ml of 0.25% bupivacaine with 1ml normal saline, at each side injected between multifidus muscle and longissimus muscle and group B of thirty patients were given 20ml of 0.25% bupivacaine with dexmedetomidine 1 mic/kg in a volume of 1 ml, at each side between multifidus muscle and longissimus muscle.

Results: There was significantly decrease in NRS as a primary outcome in group B compared to group A, and according to the secondary outcomes there were significantly decrease in serum cortisol level, consumption of isoflurane, MAP, heart rate, number of total doses of rescue analgesia and number of patients received an algesia and delay in 1st dose of rescue analgesia in groupB compared to group A and there was insignificant difference in time of extubating between both groups.

Conclusion: We concluded that adding dexmedetomidine in a total dose 2 mic/kg as we added 1 mic/kg in a volume of 1 ml to 20ml of 0.25% bupivacaine for each side in TLIP block decreases stress response to surgery, total consumption of inhalational anesthesia (isoflurane), number of patients need rescue analgesia and total doses of rescue analgesia, and delayed 1st dose of rescue analgesia.

Open Access Original Research Article

Evaluation of Hypoglycaemic, Antihyperglycaemic and Anti-lipid Peroxidative Activity of Persea americana Peel in Wistar Rats

O. N. Ilochi, T. A. Kolawole, A. N. Chuemere

Journal of Advances in Medicine and Medical Research, Page 78-83
DOI: 10.9734/jammr/2022/v34i631316

This study evaluated the hypoglycaemic, antihyperglycaemic and anti-lipid peroxidative  activity of Persea americana peel in experimental rats. 60 male wistar rats were used for this study which lasted for 42 days. The animals were randomly grouped as: A-Normal control (feed + distilled water), B- Glibenclamide 0.6mg/kg/day, C- Avocado peel extract 50mg/kg, D- Diabetic, E- Diabetic + glibenclamide 0.6mg/kg/day, F- Diabetic + avocado peel extract 50mg/kg.  Fasting blood glucose and blood level of glycated hemoglobin (HbA1C) were assayed for. With standard protocols, the heart and kidney of each animal was collected for tissue homogenization. Biochemical analysis of tissue homogenates includes Thiobarbituric acid reactive substances (TBARS) and isoprostanes (F2isoP). This study revealed a possible link between oxidative stress and hyperglycaemia in diabetic conditions. Avocado peel, dose and time-dependently reduced blood glucose level below normal as well as products of lipid peroxidation. Determination of the possible mechanisms by which avocado peel affects these biomarkers may be indispensible to medicinal research. This study revealed further therapeutic potential of avocado peel.

Open Access Original Research Article

Correlation of CT scan Chest Severity Score with Serum Ferritin in COVID-19 Disease: A Retrospective Study

Naramalli Madhavi Latha, Angirekula Saseekala, Lalitsiri Atti

Journal of Advances in Medicine and Medical Research, Page 84-92
DOI: 10.9734/jammr/2022/v34i631317

Background: COVID-19 disease is due to SARS-CoV-2 Virus with its rapid progression causing severe and fatal complications like Pneumonia.  CT scan chest and inflammatory biomarkers like serum ferritin, helpful in screening, clinical management and prevention of serious complications of the Covid-19 disease are to be investigated and assessed.

Aims and Objectives: This study is aimed to assess the association between the CT Scan Chest severity score and the Serum Ferritin levels in COVID -19 disease in predicting clinical severity with categorization into different risk groups to identify patients at risk of fatal complications to ensure optimal resource allocation.

Materials and Methods: This retrospective observational study in a Govt. Medical college attached Tertiary care hospital for COVID –19 disease in Andhra Pradesh from 1st to 31st October 2020 included 76 patients of Covid-19 disease of > 20 years of age admitted with laboratory confirmed RT PCR diagnosis of Covid – 19 disease. Data was collected from the hospital records of the patients on demography, radiological imaging of CT scan chest severity score and laboratory measurements of Serum Ferritin levels and tabulated with the results expressed as mean ± SD.  The disease severity was classified as mild (1-8), moderate (9-15) and severe (16-25)  based on CT scan chest Severity scoring. Then the association between CT scan chest severity score and serum ferritin levels was studied, assessed and  correlated.

Results: Study data of a total of 76 COVID –19 positive patients was analysed and summarized. 54 patients (71%) were Males and 22 patients (29 %) were Females. Mean age (Years) of the patients was 52 ±13.2 years with males and females as 53.11±13.45 and 50.18 ±11.71, respectively. Based on the 25 point CT scan chest severity score, 50 % (38 patients) were in the mild grade (1 -8) with a mean ±SD of 4.74±2.44, 43.42% (33 patients) were in the moderate grade (9 - 15) with a mean ±SD of 11.31 ± 2.06 and 6.58% (5 patients) were in the severe grade (16 -25) with a mean ±SD of 18.4 ± 3.29. The mean ±SD values of Serum Ferritin were 261.22±377.12ng/ml, 431.14 ±284.69ng/ml and 870.8±928.06ng/ml with mild, moderate and severe grade of CT chest severity score respectively. Statistically significant correlation was found between between the CT Chest Severity Score and Serum Ferritin levels.

Conclusion: Serum ferritin levels were observed to be high in the CT scan chest positive group and so the serum ferritin levels measured at the time of admission predict radiological severity. This positive correlation between the CT Chest Severity Score and Serum Ferritin levels can predict clinical severity of Covid -19 disease with categorization into different risk groups helping in the clinical management, prevention of serious complications and disease outcome.

Open Access Original Research Article

Medical Intern’s Knowledge Attitude and Practice towards Specializing in Ear, Nose and Throat Surgery in a Tertiary Hospital

U. A. Oparaodu, T. C. Uzosike

Journal of Advances in Medicine and Medical Research, Page 93-102
DOI: 10.9734/jammr/2022/v34i631321

Background: Medical doctors after graduating are expected to have a year of internship in an approved training institution. During the time of internship, the medical interns are referred to as House Officers who go through different clinical rotations which may alter their interest in a field.

Aim: The aim is to determine the area of interest in specialization by House Officers of Rivers State University Teaching Hospital (RSUTH) and determine their general knowledge, attitude, and practice of Ear, Nose, and Throat (ENT) Surgery.

Method: This is a facility-based cross-sectional study design. The study population was House Officers in RSUTH. A descriptive cross-sectional study design was employed and a semi-structured questionnaire was administered to obtain information from 150 participants after obtaining ethical approval for the study. Data were analyzed using IBM SPSS version 25. Descriptive frequency analysis was done for all variables. Chi-square test was used to assess the association between socio-demographic characteristics and knowledge about ENT Surgery

Result: The most common age range was 20-29 years 86 (57.3%), with equal gender distribution. The research highlighted good knowledge of ENT surgery among 110 (73.3%). Months of practice as interns and being married were significantly associated with good knowledge of ENT, p<0.05. Majority of the interns desire to specialize in ENT Surgery 24(16%) and Obstetrics and Gynaecology.

Conclusion: The findings show a growing interest in ENT specialization among interns. Increasing the exposure of interns to this area of medical specialization can enhance their knowledge and interest to specialize in ENT surgery.

Open Access Review Article

Surgical Management of Chiari 1 Malformation in the Paediatric Population: A Systematic Review and Meta-analyses of Observational Studies

Akhigbe, Taiwo, Zolnourian, Ardalan

Journal of Advances in Medicine and Medical Research, Page 9-18
DOI: 10.9734/jammr/2022/v34i631307

Background: Chiari 1 malformation (C1M) is a congenital malformation in the paediatric population is commonly encountered and often requires surgical management. Currently there is no agreed consensus on the appropriate and specific surgical technique for management of paediatric cases of C1M. The purpose of this systematic review and meta-analysis is to compare the clinical outcomes of posterior fossa decompression with duraplasty (PFDD) to posterior fossa decompression alone (PFD) in paediatric patients.

Methodology: Systematic review of electronic literature databases searched from January 1997 to March 2017 of paediatric patients that had posterior fossa decompression with comparative analysis of PFD and PFDD were considered for inclusion. A Meta-analyses on the retrieved data was performed.

Results: Nine reports of eligible studies involving 3404 patients met the inclusion criteria. Of the 3404 patients, 1965 were treated with PFD alone while 1439 were treated with PFDD. Mean age range of 9.6 year to 11.1 years. Patients undergoing PFDD has significantly higher rates of pseudomeningocele formation OR 1.91, 95% C1 (1.30, 2.82) and lower complication rates OR 1.30, 95% CI (1.06, 1.61) than PFD. No significant difference in clinical improvement, reoperation rates, CSF leaks, wound infection and incidence of aseptic meningitis were observed.

Conclusion: PFDD is associated with fewer complications when compared to PFD alone. However the incidence of pseudomeningocoele formation is more commonly encountered following PFDD compared to PFD. PFDD is also more commonly performed following a failed improvement in symptomatology following PFD. Multicentre randomised controlled studies are needed to definitively identify the gold-standard technique for the management of  answer to best surgical technique.