Open Access Case Report

Extensive Chronic Type B Aortic Dissection Extending to the Left Common Femoral Artery a Rare Case Report

Muneera Al Taweel, Ahmad Alhajji, Sarah Almukhaylid, Naimah Alnaim

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2022/v34i1031350

Background: Aortic dissection is a potentially fatal condition, defined as an injury in the innermost layer of the aortic wall leading to high-pressure blood flow between the layers of the aorta, creating a false lumen. CT aortogram is the gold standard for diagnosing AD due to its high sensitivity and specificity. Treatment of acute type a aortic dissection (TAAD) is by surgery while acute type B aortic dissection (TBAD) is managed by medical therapy.

Aim: Recognition of aortic dissection and its different clinical presentations.

Methods: Herein we report a 47-year-old man presenting repeatedly for years to the Emergency Department of various hospitals in Saudi Arabia with symptoms of chest pain that were thought to be from Acute coronary syndrome (ACS), but later diagnosed as aortic dissection type B.

Conclusion and Results: The incidence of TBAD is under-reported and might be misdiagnosed for years.

Open Access Original Research Article

Evaluation of Retinal Nerve Fiber Layer Thickness in ‎Axial High Myopic Patients after Uncomplicated Phacoemulsification

Ahmed Awad Fadda, Said Mohammad Shalaby, Rabab Mohamed El Seht, Mohamed Mostafa Khater

Journal of Advances in Medicine and Medical Research, Page 7-17
DOI: 10.9734/jammr/2022/v34i1031351

Background: ‎On examining the RNFL thickness by OCT, the media opacity caused ‎by cataract will increase light scattering

and absorption, so the RNFL thickness measurement can be increased after uncomplicated cataract surgery also, inflammatory reaction by mechanical injury of phacoemulsification ‎surgery, traction reaction of optic nerve head induced by parts of vitreous liquefaction in ultrasonic emulsification process, with the addition of optic ‎neuropathy from ultrasonic energy. For all above, these factors could increase NFL thickness.‎

Aim: Evaluation of retinal nerve fiber layer thickness in axial high myopic ‎patients after uncomplicated phacoemulsification.‎

Patients and Methods: Our patients collected from outpatient clinic of Ophthalmology ‎department; Tanta University and outpatient clinic at Ophthalmology ‎department of Matarya Teaching Hospital during the period from December 2019 to June 2020 and extended to December 2020 due to Covid_19 ‎pandemic.‎

Results: This study including 20 eyes of high axial myopic  cataracts patients (group Ⅰ) and 10 eyes of normal cataracts patients (group II)  from which age range between (50-70) years old , males were (30%) and females were (70%) in group Ⅰand males (50%) were equal to female (50%) in group II.

Conclusion: There is a significant increase in thickness of peripapillary RNFL measured by OCT after 1 week of uncomplicated phacoemulsification cataract surgery. ‎This increase in thickness occurs as the media opacity caused by cataracts increases the light scattering and absorption thus affects the quality ‎of measurements which improves after cataract extraction.‎

Open Access Original Research Article

Assessment of Sleep Quality among Consumers of Selected Medications and Substances

K. V. Ramanath, Suhana Shameer, Sourabh Suresh, Mbahaotu Faith Chukwuka, Akshith S. Shetty, . Bhavana

Journal of Advances in Medicine and Medical Research, Page 18-43
DOI: 10.9734/jammr/2022/v34i1031352

Background: Sleep is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during rapid eye movement (REM) sleep, and reduced interactions with surroundings. It is distinguished from wakefulness by a decreased ability to react to stimuli, but more reactive than a coma or disorders of consciousness, with sleep displaying different, active brain patterns. Some of the most serious potential problems associated with chronic sleep deprivation are high blood pressure, diabetes, heart attack, heart failure, or stroke. Other potential issues include obesity, depression, impairment in immunity, and lower sex drive.

Method: This was a cross-sectional, survey-based study. The data was collected by one-on-one telephonic and in-person interviews with the respondents. They were informed about the study and recorded their consent in the same data collection form. The consented subjects were administered with a self-assessed questionnaires Pittsburgh sleep quality index(PSQI); the obtained data will be subjected to descriptive statistical methods.

Results: A total number of 502 patients/subjects are included in this study. The age below 30 years showed that the sleep quality was very mildly disturbed(6.65±3.77), in the age category between 30-60 years showed that the sleep quality is little worse or disturbed(11.51±3.60) and in the age category above 60 years showed that the sleep quality is worse(13.31±2.67) than the other two age groups.

Conclusion: Based on the PSQI global score assessment, the age category below 30 years represented that the sleep quality disturbance is very mild, whereas in the middle-aged group between 30-60 years, the sleep quality disturbance is moderate, and in the age category above 60 years the sleep quality disturbance is more than the age as mentioned earlier groups.

Open Access Original Research Article

Diagnostic Value of Trans-vaginal Sono- Elastography in Discrimination of Cervical Neoplasms

Asmaa Said Mohamed Hedia, Ayman Abd Elaziz El-dorf, Rania Essam-el-dein Mohamed Ali, Manal Ezzat Badawy

Journal of Advances in Medicine and Medical Research, Page 44-56
DOI: 10.9734/jammr/2022/v34i1031353

Background: Trans-vaginal ultrasound is the most widely used imaging method to screen women with cervical cancer and other cervical masses, due to its wide availability, low cost and no radiation.

Aim of the Work: The purpose of this study is to demonstrate the role of sono-elastography in differentiating benign from malignant cervical masses. Benign tumours are typically soft, but malignant ones are typically hard.

Patients and Methods: The study was carried out on thirty patients, who referred to Tanta Diagnostic Radiology and Medical Imaging Department, for evaluation of clinically suspected cervical masses, during the period from March 2018 till December 2020. Their age ranged from 37 years to 66 years with a mean age of 49.73 (±7.65 SD) years.

Results: This Prospective study was carried out on thirty patients, who referred to Diagnostic Radiology and Medical Imaging Department, for evaluation of clinically suspected cervical masses. Their age ranged from 37 years to 66 years old with a mean age of 49.73 years (±7.65 SD).

Conclusions: Transvaginal sonographic elastography is a promising diagnostic tool that can be used in combination with conventional sonography to distinguish malignant from benign endometrial lesions. Both qualitative and quantitative methods can be used to enhance elastography's diagnostic performance, and SR has showed excellent diagnostic performance.

Open Access Original Research Article

The Influence of Modern Lifestyle on the Health of Medical Students in a Medical School in Dominica

Schilo La Victoire, Stephanie Ukwandu, Oghenetega Ejuone, Esther O. Monday

Journal of Advances in Medicine and Medical Research, Page 57-64
DOI: 10.9734/jammr/2022/v34i1031354

Background: A healthy lifestyle is a way of living that reduces the risk of being severely ill. In 1967, the World Health Organization (WHO) defined health as “of complete physical, mental and social well-being and not merely the absence of disease or infirmity ». An unhealthy diet and lack of physical activity are in the lead for global health risks.

Aim: This study explored the impact modern lifestyle has on the health of medical students

Methods: Our study included a literature review, and a questionnaire consisting of 24 questions which were answered by 76 participants which targeted; diet, exercise regimen, sleep cycle, alcohol, substance use, and technology use.

Results: From the responses, 63.1% of respondents practice a sedentary lifestyle, 68.4% skip breakfast and 35.5% have an unhealthy diet.

Conclusion: There is a need for individuals to pay attention to their daily practices as modern lifestyle can have a negative impact on quality of life.

Open Access Original Research Article

Role of Diffusion Weighted Magentic Resonance Imaging in Evaluation of Hepatocellular Carcinoma Post Chemoembolization

Ahmed Hassan Ali Moustafa, Hanan Ahmad Nagy Mohammed Saleh, Atef Hammad Teama

Journal of Advances in Medicine and Medical Research, Page 65-75
DOI: 10.9734/jammr/2022/v34i1031355

Background:  Hepatocellular carcinoma (HCC) is the fifth most common type of cancer in the world and the third most prevalent frequent death reason in patients who suffers from malignant tumors. The apparent diffusion coefficient (ADC) is a method for measurement of  the water movement within tissues. Tumors that are viable have a high cellularity, and the cells' membranes are intact which water molecules' mobility is restricted, leading to a small ADC. But from the other hand, necrosis increases the permeability of the cell of the membrane, permitting water molecules to circulate freely and resulting in an elevation in the ADC's relative value. This study aimed to describe the use of diffusion weighted MRI to evaluate hepatocellular carcinoma in the setting of trans-arterial chemoembolization (TACE).

Methods: This study was carried out on 30 patient (males: 22, eight females) aged 42 to 75 years with biopsy-proven HCC, candidate for trans arterial hepatic chemoembolization as a plan of treatment. They were referred from Oncology Department to MRI unit in radiology department over a period of 1 year starting in June 2018 to June 2019.

Results: According to diffusion weighted Imaging (DWIs) and ADC values, there were 4 TP (13.33%), 22 TN (73.33%), 2 FP (6.66%) and 2 FN (6.66%) studies. The P-value by Fisher’s Exact was <0.05 denoting agreement between the DWI and ADC findings and the standard of references. Regarding the false negative studies by diffusion MRI, On diffusion images, there was a loss of signal or a mild sustained hyperintensity with a bright ADC map, so it was considered as well ablated lesion. Follow up triphasic CT or dynamic MRI after 3-6 months shows lesion enhancement at arterial phase and wash out at both venous and delayed phases with restricted diffusion. The optimal cutoff value for sensitivity and specificity is 1.069; at this ADC value, the sensitivity is 66.66 percent and the specificity is 91.66 percent.

Conclusions: ADC obtained from diffusion-weighted magnetic resonance imaging has developed into a a useful biomarker for the response of tumours to therapy.  Analysis of the ADC value is helpful in detecting the presence of residuals in non-successfully ablated lesions.

Open Access Original Research Article

The Role of Interleukin-6 in Anemia of Patients with Chronic Kidney Disease, in Pre-dialysis Stage

Eman Ahmed Mohamed Esmail, Mohamed A. Safa, Noha E. Esheba, Amira Y. Abd-Elnaby, Hegazy Mohamed Hegazy

Journal of Advances in Medicine and Medical Research, Page 76-82
DOI: 10.9734/jammr/2022/v34i1031356

Background: Anemia is common in chronic kidney patients. Interleukin-6 plays an important role in anemia. No studies were performed on the role of Interleukin-6 in anemia of pre-dialysis adult chronic kidney disease, so we performed this study to highlight this point.

Methods: A case control study conducted on 50 patients with CKD and 30 apparently healthy volunteers as a control group. They were further subdivided into: 1a: 12 CKD patients with 12 > Hb >10 and 1b: 38 CKD patients with moderate or severe anemia. Hb <10 gm/dl. Group 2: 30 healthy volunteers. All participants were subjected to full history taking, complete clinical examination, routine laboratory investigations including CBC, KFTs, LFTs and serum IL6 assay by ELIZA.

Results: Hb, HCT and MCV were significantly lower among group Ia and group Ib patients in comparison to group II, but CKD patients’ groups had significantly higher IL-6 level than control group with no significant difference between patients’ groups (group Ia and group Ib). Significant negative correlation was detected between IL6 and both Hb and HCT among patients and control group.

Conclusions: IL6 is significantly higher in chronic kidney patients in comparison to controls. It also correlates negatively with hemoglobin level and hematocrit. IL6 has a good sensitivity of 83.3% at a cutoff value of 74.7ng/l. So, it can be used as a prognostic marker of anemia in chronic kidney patients.

Open Access Original Research Article

Prevalence and Correlation of Abnormal Atherogenic Cardiovascular and Ankle Brachial Indices with Predicted 10-Year Atherosclerotic Cardiovascular Disease Risk among Patients with Type 2 Diabetes in Central Uganda

William Lumu, Silver Bahendeka, Ronald Wesonga, Davis Kibirige, Ronald Kasoma Mutebi, Emmanuel Ssendikwanawa

Journal of Advances in Medicine and Medical Research, Page 83-95
DOI: 10.9734/jammr/2022/v34i1031357

Aim: The aim of this study was to determine the prevalence of abnormal atherogenic cardiovascular indices, Ankle brachial index and their correlation with the predicted 10-year atherosclerotic cardiovascular disease risk (ASCVD) among type 2 diabetes patients in Central Uganda.

Methodology: Five hundred patients aged 40-79 were consecutively selected.  Socio-demographic data was collected with a pre-tested questionnaire. Physical and laboratory measurements were performed. Atherogenic cardiovascular indices such as Atherogenic Index of Plasma (AIP), Atherogenic Coefficient and Casteri Risk Index I& II were determined. Ankle Brachial Index (ABI) was measured. We used the revised Pooled Cohorts Risk Equations to quantify the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. The proportions and percentages of atherogenic cardiovascular indices, ABI and 10-year ASCVD risk were determined. Pearson chi-square correlation analyses were performed to determine correlation. Statistical significance was set at P<0.05.

Results: The prevalence of elevated AIP was 56.45%, Casteri Risk Index I 68.4%, Casteri Risk Index II 32.6 and Atherogenic Coefficient 64.8%. Low ABI of<0.9 was found among 25.4% while 0.6% had an ABI>1.3.Atherogenic cardiovascular indices significantly correlated with 10 year ASCVD risk with Casteri Risk Index I (r=0.185, P<0.001), Casteri Risk Index II (r=0.127, P=0.004), Atherogenic Coefficient r=0.186, P<0.001). AIP was positively but not significantly correlated with ASCVD risk (r=0.053, P=0.241). ABI negatively correlated with the ASCVD risk (r=-0.225, P<0.001). 

Conclusion: Prevalence of abnormal atherogenic cardiovascular indices and ABI was high. They correlated with the ASCVD risk. Atherogenic cardiovascular indices and ABI can be used to screen and manage ASCVD in our setting.