Open Access Original Research Article

Effect of Endoscopic Management of Unresectable Malignant Biliary Strictures on Patient’s Quality of Life

Uzma Soomro, Sajida Qureshi, Raja Taha Yaseen Khan, Farzana Memon, Hamza Akhter, Ghulam Ali Najero

Journal of Advances in Medicine and Medical Research, Page 9-13
DOI: 10.9734/jammr/2022/v34i831335

Background: Biliary strictures(BS) possess challenging diagnosis, requiring a multidisciplinary approach. In gastrointestinal clinical practice, the occurrence of biliary strictures is quite common. Multiple diagnostic techniques are used to examine BS in which endoscopic management is considered comparatively effective and non-invasive intervention.

Objective: The study aimed to observe the impact of the endoscopic management of unresectable malignant biliary strictures on the patients' quality of life (QoL).

Methodology: This cross-sectional study was conducted at the Surgical Ward IV Civil Hospital Karachi, Pakistan. A total of 80 patients with diagnosed unresectable malignant stricture, aged between 18 to 70 years, those with disease duration of more than eight weeks and life expectancy > 1 month were included in the study. In addition to the baseline characteristics along with the pre and post-treatment quality of life was assessed, and the mean values were compared statistically using SPSS version 19.0.

Results: The mean total score of QoL improved from 71.47 ± 0.88 at baseline to 84.12 ± 1.93 after 30 days of endoscopic management of unresectable malignant biliary strictures.

Conclusion: There was a significant improvement in the patient's QoL after 30 days of endoscopic management of unresectable biliary stricture.

Open Access Original Research Article

An Analysis of 644 Upper GI Endoscopies Performed in a Nigerian Tertiary Health Institution

Bamidele Israel Omolabake, Simon Wuam

Journal of Advances in Medicine and Medical Research, Page 14-19
DOI: 10.9734/jammr/2022/v34i831336

Upper GI endoscopy is an important tool in the diagnosis and management of gastrointestinal disorders and is being employed for a similar purpose in BSUTH, Makurdi. We sought to audit the practice in this institution over a 7-year period by reviewing the records in the procedural register. We found that most of the indications were diagnostic, with a few therapeutic applications. The diagnostic yield included a spectrum of benign and malignant diseases with Gastroesophageal reflux disease (GERD), gastro-duodenitis and peptic ulcer disease being the most frequent diagnosis. The therapeutic application included percutaneous gastrostomy tube placement, haemostasis of bleeding peptic ulcers, endoscopic variceal band ligation and sclerotherapy of varices, and gastro-oesophageal foreign body removal. We conclude that routine upper gastrointestinal endoscopy is feasible in our settings though, an overwhelming majority of these are diagnostic as opposed to therapeutic. There is need to expand the scope of endoscopy in our setting. Major challenges need to be addressed to sustain and expand the practice of UGI endoscopy in our setting.

Open Access Original Research Article

A Prospective Study of Leptospirosis as a Differential Diagnosis of Dengue like Illness

Hemant Makhija, Shilakha .

Journal of Advances in Medicine and Medical Research, Page 20-26
DOI: 10.9734/jammr/2022/v34i831337

Background: Leptospirosis is both a zoonotic and environmental disease. The bacteria are hosted in animal kidneys for months and even years, and the bacteria are released in the environment by the urine of these animals. The transmission to humans occurs by contact with infected animals or contaminated water. There are different entry points for this contamination, it could be a skin abrasion, it could be through the mucous membranes, it can also occur through inhalation of droplets of urines for instance during farming activities and sometimes, it occurs by drinking water. Clinical presentation of leptospirosis mimics dengue as pyrexia with thrombocytopenia is common in both.

Methods: We have included all patients between age group of 0-18 years with complaints of fever. Laboratory investigation showed thrombocytopenia but negative dengue serology and raised Serum glutamic oxaloacetic transaminase/ Serum glutamic pyruvic transaminase (SGOT/SGPT) and no other obvious cause of illness. Hence leptospira serology was done.

Results: Total of 15 patients were cases of dengue like illness, out of which Leptospira serology samples came positive in 60% (9). Total number of cases of dengue like illness are 15 out of which 66.6%patients belonged to >10 years (11-18) & 33.33 % patients were <10 years and gender ratio was 66.6% (10) male & 33.33% (5) females. The patients who were diagnosed as dengue like illness were given antibiotic- 46.6% (7) were given Doxycycline & 53.3% (8) cases were given Azithromycin. Clinical improvement with increase in their platelet count was seen within 48 hrs. of starting the antibiotic in all of them.

Conclusion: Leptospirosis should be considered as an important differential diagnosis while treating patient of dengue like illness. Consider treating such patient with doxycycline/azithromycin as this result in clinical improvement & may prevent any complications.

Open Access Original Research Article

Awareness, Adherence and Determinant Factors among Pregnant Mothers on Lifelong Tetanus Toxoid Vaccination as Part of the National Immunization Scheme

Taiwo Olufunmilayo Kuye-kuku, Fatimat Motunrayo Akinlusi, Folasade Dolapo Haleemah Olalere, Joy Onyinyechi Chionuma, Yusuf Abisowo Oshodi, Tawaqualit Abimbola Ottun

Journal of Advances in Medicine and Medical Research, Page 27-34
DOI: 10.9734/jammr/2022/v34i831338

Objective:This study determined pregnant women’s awareness, and determinants of uptake of National immunization recommendations for a maternal tetanus vaccine.

Study Design: A cross-sectional study of 347 eligible pregnant women who attended the booking antenatal clinic of institute of maternal and child health (IMCH). Structured interviewer-administered questionnaires, captured socio-demographic the mothers’ knowledge level of routine tetanus immunization and factors affecting uptake. Data were analyzed using the IBM SPSS version 20 statistical computer software package. Descriptive and inferential statistics were applied.

Results: The majority [66%} of the respondents were not aware of the national immunization schedule for tetanus toxoid. Only 28.8% (100) women could correctly state the dosing interval for the vaccination. The study showed that 184 women ought to have completed the vaccination based on their history, only 36 (19.6%) reported completion. Age, parity, marital status and women’s occupation were significantly associated with tetanus vaccine uptake in pregnant women.

Conclusion: Awareness of maternal tetanus vaccination is low, thus increase may be achieved through antenatal health talk and policies.

Open Access Original Research Article

Surgical Resection for Colorectal Cancer Improves Survival in Uganda

Richard Wismayer, Julius Kiwanuka, Henry Wabinga, Michael Odida

Journal of Advances in Medicine and Medical Research, Page 35-47
DOI: 10.9734/jammr/2022/v34i831339

Introduction: In Uganda and other developing low-income countries in Sub-Saharan Africa, colorectal carcinoma (CRC) incidence and mortality rates are increasing whereas in high income developed countries, CRC rates are declining. Many patients do not have access to curative surgery and oncological treatment for CRC in Uganda. In this study, we compared the survival outcomes of patients who underwent curative surgery, and, if necessary, adjuvant chemotherapy to those who did not to assess the impact of surgery and oncology care on CRC in the resource-limited setting of a low-income developing country.

Methods: Participants with a diagnosis of CRC between 1 January 2008 and 31 December 2018 were included. These patients had linked data in the Kampala Cancer Registry and medical records from hospitals in Uganda. Data on whether the patients had or did not have curative surgery and adjuvant chemotherapy were obtained. Our outcome variable was survival at 3 years. We computed and compared survival using the log-rank test.

Results: Two hundred and forty seven patients were included in the study cohort. These were 177 (71.66%) patients that had curative surgery, while 70 (28.34%) had no curative surgery. Curative rectal cancer surgery had a better survival than no curative surgery (p=0.003). Curative colon cancer surgery tended to have a better survival than no surgery (p=0.137). Curative surgery and adjuvant chemotherapy showed better survival than no surgery with no adjuvant chemotherapy (p=0.007).

Conclusions: In a resource-limited environment, curative surgery and if necessary, combined with adjuvant chemotherapy improves survival. The findings in our study therefore serve to encourage the expansion of CRC care by improving the surgery and oncology infrastructure in resource-limited environments due to the increasing burden of CRC.

Open Access Original Research Article

Prevalence and Pattern of Perineal Tear Following Vaginal Birth in Kano, Northern Nigeria, A 2 Year Study

Hauwa Musa Abdullahi, Muhammad Zakari, Murtala Yusuf, Umar Sabo

Journal of Advances in Medicine and Medical Research, Page 48-53
DOI: 10.9734/jammr/2022/v34i831340

Introduction: Perineal trauma following vaginal birth is a common postnatal complication. As many as 85% of women suffer some form of perineal trauma, which has both short and long terms effects on women’s physical, psychological and social wellbeing. It can also occasionally disrupt breast feeding, family life and sexual relationships.

Objectives: To assess the incidence and pattern of perineal tear following vaginal delivery in Aminu Kano Teaching Hospital, Kano, North Western Nigeria.

Methods: A retrospective review of the records of all parturients who delivered in the labour ward of Aminu Kano Teaching Hospital Kano, during the period of the review (1st January 2016 to 31st December 2017). Necessary information for the review such as age, parity, type of tear, birth weight, APGAR score, and blood loss were retrieved and recorded in a proforma. The data collected was analysed using SPSS (version 23) statistical software and the result was presented as frequencies and percentages using simple statistical tables.

Results: The incidence of perineal tear in AKTH was found to be 11.4%. First and second degree tears were common among multiparous women, while third and fourth degree tears were common among primiparous patients. There was a statistically significant association between parity and severity of perineal tear.

Conclusion: The incidence of perineal tear is high in the hospital, antenatal and intrapartum risk reduction will play a vital role in reducing the incidence and severity of this condition, thereby improving the associated postpartum morbidity.

Open Access Original Research Article

Incidence of Endometriosis in Symptomatic and Asymptomatic Cases of Primary Infertility in Tanta University Hospital

Gehad Emad Hassan, Naglaa Ali Hussein, Maha Mostafa Shamloula, Mohammed Ismael Abdo

Journal of Advances in Medicine and Medical Research, Page 54-61
DOI: 10.9734/jammr/2022/v34i831341

Background: Endometriosis is the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. Some women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. The aim of this study was to detect the incidence of endometriosis among symptomatic and asymptomatic cases of primary infertility in Tanta University Hospital over one year.

Methods: This prospective observational study was conducted on 50 females aged between 20 and 35 years old, with unexplained infertility, symptoms of endometriosis and infertility for 1 or more years. Patients were divided into two equal groups: group (1):  cases with unexplained infertility for 1 year or more and group (2):  cases with symptoms of primary infertility and endometriosis for 1 year or more. Patients were subjected to the following: meticulous history taking (personal, obstetric and menstrual history, history of present illness, past history 'medical and surgical'), thorough clinical examination, routine laboratory investigations, imaging techniques (ultrasound and HSG) and laparoscopy for diagnosis of possible presence of endometriosis.

Results: Endometrioma size was significantly higher in group 2 compared to group 1 (P value = 0.020). Stage 1 of endometriosis was significantly lower in group 2 compared to group 1 and Stage 2, 3 and 4 of endometriosis were significantly higher in group 2 compared to group 1 (P value = 0.04). Dysmenorrhea of endometriosis after treatment were significantly higher in group 2 compared to group 1(P value <0.001). Chronic pelvic pain was significantly higher in group 1 compared to group 2 (P value <0.001).

Conclusions: The presence of dysmenorrhea, dyspareunia, pelvic pain, infertility, and clinical signs of cul-de-sac tenderness raise the suspicion of endometriosis in infertility patients.

Open Access Review Article

The Impact of Periodontal Therapy on Periodontal Patient with Type 2 Diabetes Mellitus

Fahmida Khatoon, Amal Daher Alshammari, Ruba Mustafa Elsaid Ahmed, Amal Bakri Mohammed Elhag, Farida Habib Khan, Salma Ahmed Ali Babiker, Hemat E. El-Horany, Ayesha Akbar Khalid, Zahid Balouch

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2022/v34i831334

Diabetes is a common among general population with many oral manifestations; persistent deprived glycemic control has been associated with the incidence and progression of diabetes related complications including gingivitis and periodontitis which the most common cause of tooth loss, evidence suggests that periodontitis affects glucose control in diabetes.

The disease evoked bacteremia can cause elevation in serum pro inflammatory cytokines leading to elevated lipid levels and ultimately inflicting a hypoglycemic agent resistance syndrome and tributary to destruction of duct gland beta cells. Treating chronic odontology infections is crucial for managing polygenic disorder. Aim of this literature review is to look at the impact of odontology medical aid on glycemic management in sort II diabetic patients.