Open Access Case Study

Niemann Pick Disease – Rare Cause of Chronic Liver Disease-Case Series

Raja Taha Yaseen Khan, Ghous Bux Soomro, Sandeep Kumar, Hina Ismail, Arshad Ali Jariko, Mahboob Jan, Ghazi Abrar, Danish Kumar, Munir Tareen, Muhammad Qaiser Panezai, Abbas Ali Tasneem, Syed Mudassir Laeeq, Farina Hanif, Nasir Hasan Luck

Journal of Advances in Medicine and Medical Research, Page 63-67
DOI: 10.9734/jammr/2022/v34i1131367

Niemann pick disease refers to a group of autosomal recessive disorder lysosomal lipid storage disorders with a multisystem involvement with a wide variety of clinical manifestations. The pathogenesis of disease is yet to be defined clearly. Here, we report to you a series of two cases including that of a three-year old girl and a four-year old boy.

Open Access Original Research Article

Evaluation of Risk Factors in COVID- 19 Patients Presenting in a Nigerian Teaching Hospital

Voke Peter Orugbo, John Ohaju-Obodo

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2022/v34i1131358

Aim: The study's goal was to look into the relationship between disease incidence, clinical symptoms, and comorbidities in COVID patients at the Delta State University Teaching Hospital Isolation Centre in Delta State, Nigeria, to see if they were COVID risk factors.

Study Design: The study relied on case notes and clinical records of 80 study participants

Place and Duration of Study: The study was conducted at the COVID-19 Isolation Centre affiliated to Delta State University Teaching Hospital (DELSUTH), Oghara, Delta State, Nigeria. It was a one-off sampling study.

Methodology: COVID-positive patients at the Isolation Centre were separated from the Control group. In this study, the control group refered to those who tested negative or unconfirmed. Participants were people in the community who appeared to be of a similar age and appeared to be in good health. Both groups of participants' clinical records were acquired. A total of 80 participants were thus recruited for the study. The clinical records of both groups were compiled and examined after due authorization.

Results: The results showed that 51 of the 80 participants tested positive for COVID-19 at the designated study center. The majority of COVID patients were between the ages of 30 and 59, which is human active age. The majority of COVID patients had diabetes miletus,  accounting for more than 25% of the total. The majority of the participants had normal blood pressure: 34.6% of unconfirmed cases, 52.9% of COVID patients, and 100% of those who were COVID negative.

Conclusion: Respiratory failure, AKI, cardiac arrest, hypoxic brain injury, UTI, and Gastritis were among the most common complications identified by study participants.

Open Access Original Research Article

Validation of Electrical Cardiometry Measurements Compared to Transthoracic Echocardiography in Fluid Responsiveness in Sepsis

Mohammed Said El Sharkawy, Mohammed Shebl Abdelghany, Ahmed Ali El Dabe, Ahmed Ali Abd El Hafez

Journal of Advances in Medicine and Medical Research, Page 10-20
DOI: 10.9734/jammr/2022/v34i1131359

Background: Severe sepsis and septic shock patients have a broad range of hemodynamic characteristics. A better understanding of the hemodynamic profile and response to therapy can lead to more effective treatment and consequently a lower mortality and morbidity. The current research work was designed to investigate the non-invasive diagnostic accuracy and agreement of electrical cardiometry (EC) with transthoracic echocardiography (TTE) for fluid responsiveness in sepsis.

Methods: This prospective cohort study was assessed on 25 patients showing clinical criteria of sepsis and developed hypotension. All patients were subjected to simultaneous measurement by EC and TTE. Fluid was administered if stroke volume (SV) measured by TTE increased by > 10% after the fluid challenge up to 30 mL/kg else vasopressor infusion was initiated.

Results: Electrical cardiometry significantly predicted fluid responsiveness in sepsis compared to TTE with 81.4% sensitivity and 90% specificity. There was an insignificant difference between SV index (SVI), cardiac index (CI), SV, and cardiac output (CO) estimated by TTE and by EC. The mean bias between SV measured by TTE and by EC was 0.25 ± 3.4 ml. The mean bias between TTE and by EC was 0.10 ± 1.78 mL/m2 in SVI, 0.01 ± 0.35 L/min in CO and 0.009 ± 0.18 L/min/m2 in CI.

Conclusions: Electrical cardiometry significantly predicted fluid responsiveness in sepsis compared to TTE with good agreement between measurements of EC and TTE.

Open Access Original Research Article

Fluid Management Using Cardiometry in ARDS Patients

Mostafa Mohamed Shaheen, Ahmed Said Elgebaly, Ghada Fouad Elbaradey, Amira Mahfouz Alqablawi

Journal of Advances in Medicine and Medical Research, Page 21-27
DOI: 10.9734/jammr/2022/v34i1131360

Background: Fluid management is a complicated subject and one of the most difficult facets of medical care. Fluid balance has been shown to improve respiratory physiology for acute respiratory distress syndrome (ARDS) patients. The aim of this study was to assess the role of electrical cardiometry (EC) in fluid management in ARDS.

Methods: This pilot interventional study was carried on 15 patients who were 18 years or older and fulfill the Berlin definition of ARDS. Fluid management was guided by EC.

Results: ICU stay has a mean value of 13.67 ± 4.58 days and duration of MV has with a mean value of 10.27 ± 4.34 days. Lung injury score decreased significantly at 7, 14, 21, 28 days when compared to baseline. Intravenous fluid intake had significantly decreased in 4,5,6,7 days when compared to the 1st day. Urine output has significantly decreased in 5,6,7 days when compared to the 1st day. Hemodynamic instability was in 20% of patients, heart failure in 13.3% of patients, sepsis in 20.0% of patients and organ failure in 26.7% with no renal failure and no arrythmia.

Conclusions: EC was effective in the fluid management in ARDS as regards decreasing 28th day mortality, LIS, fluid intake, duration of MV and ICU stay.

Open Access Original Research Article

Microbiological Spectrum, Antibiogram and Bacteraemia in Biliary Tract Infections- A Study from Tertiary Centre of North India

Vibha Mehta, Versha Grebriyal, Poonam Sood Loomba, Bibhabati Mishra, Abha Sharma

Journal of Advances in Medicine and Medical Research, Page 28-40
DOI: 10.9734/jammr/2022/v34i1131362

Objectives: The present study was undertaken to understand the microbiological profile, clinical presentation, associated bacteraemia and present antibiogram pattern of various isolates from patients with biliary tract infection admitted in a tertiary care centre in India.

Methods: In this retrospective study, Bile samples were collected from adult patients admitted in our hospital and were processed as per standard protocol. The results were interpreted as per Clinical Laboratory Standards Institute (CLSI) 2020 guidelines. Bacterial isolates were categorised as MDR and PDR as per CDC.

Results: 326 bile samples were sent for aerobic culture and susceptibly testing. 197 (60.42%) of these samples were culture-positive, and the remaining 129 (39.57%) were sterile in nature. A total of 289 pathogens were isolated; Escherichia coli (37.37 % n=108) was predominant, followed by Klebsiella pneumoniae (25.60%, n=74). 170 (60.49%) isolates were resis­tant and the remaining 111 (39.50%) were susceptible to various drugs tested. 27 ESBL producing strains of E.coli( n= 20) and Klebsiella spp (n= 7) and 21 CRE producing strains of E coli ( n= 12) and Klebsiella spp( n=9) were reported . 5 isolates of Klebsie­lla spp. and a single E.coli were PDR and susceptible to colis­tin (MIC =0.5 mcg/ml) by microbroth dilution test.

Conclusion: The soaring rates of infection mainly by gram-negative bacteria are a red flag with the emergence of multidrug resistant organisms and change in the anti-microbiological spectrum and pattern of biliary tract infections, there is an urgent need for the empirical and prophylactic an­timicrobial therapy in every clinical setting.

Open Access Original Research Article

4D Ultrasound of Fetal Facial Expressions in Low and High-Risk Pregnancies as an Indicator of Fetal Neuro-Behavior in Last Trimester

Eman Mohamed Soliman, Rasha Ali Saleh, Haytham Haroun Elsaed, Noha Mohamed Abd Elmaboud

Journal of Advances in Medicine and Medical Research, Page 41-48
DOI: 10.9734/jammr/2022/v34i1131363

Background: The advancement of four-dimensional (4D) ultrasound allows for not only greater observation of foetal anatomy but also real-time analysis of foetal behaviour. The goal of this study was to use 4D ultrasonography of foetal facial expressions in the last trimester to assess foetal neuro-behavior in low and high-risk pregnancies.

Methods: This prospective study enrolled 50 pregnant females at their last trimester with high-risk pregnancies and with intrauterine growth restriction. Pregnant females were divided into two equal groups, one was pregnant females with low-risk pregnancy and the other group was pregnant females with high-risk pregnancy. All patients were subjected to full history taking and 2D and 4D ultrasound examination.

Results: Cranial sutures and head circumference, post-partum follow up and total KANET score were significantly different between two groups (P<0.001). Post-partum follow-up and total KANET score of high-risk subgroups were significantly different (P<0.001).

Conclusions: 4D ultrasound is considered now a great tool to evaluate foetal neuro-behaviour in low and high-risk pregnancies and to predict the neurological outcomes through foetal facial expressions in the last trimester.

Open Access Original Research Article

Recent Advances of Magnetic Resonance Imaging in Evaluation of Recurrent Perianal Fistula

Lubna Abd Elaziz Hamada, Mohammed Mahmoud Dawoud, Hamdy Sedqy Abdallah, Mohamed Mohamed Hefeda

Journal of Advances in Medicine and Medical Research, Page 49-62
DOI: 10.9734/jammr/2022/v34i1131364

Background: Evaluation of recurrent perianal fistulae can be challenging; knowledge of relevant pelvic anatomy and fistula classification remains crucial in the diagnosis of recurrent perianal fistula. Magnetic Resonance Imaging (MRI) has been shown to demonstrate accurately the anatomy of the perianal region. In addition to showing the anal–sphincter mechanism, MRI clearly showed the relationship of fistulae to the pelvic diaphragm and the ischiorectal fossae, especially for patients with complex and recurrent fistulae.

Objective: The aim of this study is to discuss the usefulness of high-resolution magnetic resonance imaging with contrast and/or local gel or saline injection in evaluation of recurrent perianal fistula.

Methods: This prospective study included 30 symptomatic cases with suspected recurrent perianal fistula referred to Radiodiagnosis and Medical Imaging Department at Tanta University Hospitals through period extending from May 2017 to December 2019. MRI had been done for all selected patients. Perianal fistulas were classified according to the St James’s University Hospital classification.

Results: Contrast enhanced MRI and local gel or saline injection showed 93.3% accuracy in detecting grade I, grade II and 100% accuracy with grade III, grade IV fistulae, ischeoanal abscesses and fibrotic tracts.

Conclusion: Contrast enhanced MRI with local gel or saline injection in selective cases with external oozing opening is a very useful procedure for successful management of recurrent peri-anal fistula by correct assessment of the extent of fisulae, relationship to sphincter complex, detection of secondary tracts and abscesses, aiming to reduce complications and recurrences.

Open Access Original Research Article

Socio Behavioral Factors Associated with Nocturnal Enuresis among Primary School Children in Abo Homous, Elbehira, Egypt

Sahar Abd-elazziz Hamed Elazzazy, Sanaa Abd El-fatah Mostafa Abdo, Khalil Mohamed Abbas Ayad, Samir Abd-elmageed Atlam

Journal of Advances in Medicine and Medical Research, Page 68-79
DOI: 10.9734/jammr/2022/v34i1131368

Background: Nocturnal enuresis (NE) is intermittent urinary incontinence during sleep at children aged five years old or more after exclusion of organic diseases. NE has a negative impact on life quality of children and their families. The aim of this work was to find out the prevalence of nocturnal enuresis and its socio-behavioral risk factors among primary school children in Abo Homous, Elbehira, Egypt.

Methods: This cross sectional study was carried-out in Abo Homos, Elbehira governorate. It included (106) primary schools with total number of (65,045) students distributed over 52 urban and 54 rural schools. Data were collected via a predesigned self-administered questionnaire sheet; part 1: Questions related to students as [Age, gender, demographic and student characteristics, student’s diseases], part 2 [Questions to assess familial factors] and part 3 [Question to assess criteria of NE in the studied population].

Results: The prevalence of nocturnal enuresis was 13.9%. Nocturnal enuresis was observed more in younger age groups of 6 and 7 years 23.2% & 21.2% respectively. There was no statistically significant association as regard age, gender or residence. Urinary tract infection, constipation, and caffeine beverages consumption significantly associated with NE. Family history of NE was positive in 29.1% of cases. Deep sleep and exposure to school or home (problems/violence) related significantly with occurrence of NE. Level of education and work status of parents, number of persons per room, and socioeconomic status significantly associated with occurrence of NE.

Conclusions: Prevalence of nocturnal enuresis is significantly associated with younger age, urinary tract infection, constipation, and caffeine beverages consumption, deep sleep, exposure to school or home (problems/violence), level of education and work status of parents, number of persons per room, and socioeconomic status.