Open Access Original Research Article

Hysteroscopic Finding in Patients with Secondary Infertility at Tanta University Hospitals

Enas Gamal Kabeil, Mai Nabil Ageez, Adel Elsayed Algergawy, Ahmed Hussein Abu Freikha

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2022/v34i1331373

Background: About 7.5% of married couples experience infertility. It has been reported that an abnormal uterine finding occurs in approximately 40% of infertile women. The aim of this study was to evaluate the role of Hysteroscopy in diagnosing the abnormalities of the uterine cavity among female having secondary infertility at Tanta University Hospitals.

Methods: This study was conducted on 80 women referred for diagnostic hysteroscopy due to secondary infertility. All patients were subjected to complete history taking, clinical examination and routine laboratory investigation. Patients also were subjected to vaginal speculum examination, ultrasound, hysteroscopic examination and hysteroscopic septum resection, hysteroscopic myomectomy.

Results: The mean age of the included cases was 31.46 ± 6.07 years, and their median age was 30 years with range 19 and 40 years. The highest percentage of the included cases were in the age group between 19 and 30 years (56.25%) followed by the age group between 31 and 40 years (53,75%). There were 41 housewives (51.3%) and the remaining 39 (48.7%) were working. The highest percentage of the cases came from rural areas (61.3%) and 38.7% from urban areas.

Conclusions: Our data are an additional argument to suggest hysteroscopy as part of investigation in infertile woman. Routine diagnostic hysteroscopy and ultrasound should be part of an infertility workup secondary infertility. Obesity is associated with hormonal derangement which are responsible for infertility weight loss should be considered as a first line treatment.

Open Access Original Research Article

Serum Adenosine Daminase Ativity as a Dagnostic Biomarker in Systemic lupus Eythematosus Patients

Dina Gamal Bastawesy Ghanem, Sahar Mohy Eldine Hazzaa, Abeer Abd El Monem Shahba, Hossam Abd El Mohsein Hodeib

Journal of Advances in Medicine and Medical Research, Page 12-23
DOI: 10.9734/jammr/2022/v34i1331374

Background: Adenosine deaminase (ADA) is linked to the development of autoimmune diseases. In order to assess the use of serum ADA activity in diagnosing SLE and assessing disease activity, we examined the serum ADA activity of 70 SLE patients (35 active patients and 35 inactive patients) and 15 healthy controls.

Aim: The purpose of this paper is to evaluate the importance of serum ADA activities in identifying SLE and its connection to the activity of the illness.

Subjects and Methods: This a randomized prospective efficacy-controlled study conducted on 85 adult Patients (≥ 18 years) with clinically active SLE and clinically non-active SLE and carried at Clinical Pathology Department at Tanta University Hospital.

Results: In SLE patients, serum ADA activity was substantially higher in the active patients group than in the inactive patients group when compared to the control group. The best cut-off value for utilizing blood ADA activity to diagnose SLE patients was 12.8 U/L, according to a receiver operating characteristic curve analysis (ROC) (specificity, 100 percent; sensitivity, 100 percent). For lupus patients, serum ADA activity was shown to be more useful than other conventional hematological indicators such as complement C3, complement C4, ANA, and anti-ds DNA. Adenosine deaminase levels were also linked to ESR, blood urea, serum creatinine, Hb levels, Urine albumin/creatinine ratio, anti-nuclear antibody titre, anti-dsDNA antibody, total platelet count, complement C3 and complement C4 levels.

Conclusion: Serum ADA activity might be a possible diagnostic sign for SLE, and assessing serum ADA activity can help with illness evaluation and monitoring.

Open Access Original Research Article

Comparative Study of Analgesic Efficacy of Ultrasound Guided Femoral Nerve Block versus Intravenous Fentanyl Injection in Fracture Femur Patients at Emergency Department

Asmaa Hamdy Musallam, Esraa Hamdy Nassar, Mohamed Abdelhamed Romeih, Tarek Ahmed Elshiekh

Journal of Advances in Medicine and Medical Research, Page 45-53
DOI: 10.9734/jammr/2022/v34i1331378

Aim: The aim of this work was to evaluate the analgesic efficacy of ultrasound guided femoral nerve block compared with intravenous (IV) fentanyl in fractures of the femur in patients presented to Emergency Department (ED).

Methods: This prospective, comparative, (blinded, randomized controlled clinical trial) was conducted on fifty patients with femur fracture. Patients were divided into two equal groups: group A underwent ultrasonography-guided femoral nerve block and group B given IV fentanyl 2 µg/kg). All patients underwent initial resuscitation. Intra-venous (IV) access with wide bore cannula and baseline investigation were obtained. Patients underwent X-ray imaging for diagnosis of femur fracture and FAST (Focused Assessment with Sonography for Trauma) scan on presentation at ED by ED trained physicians.

Results: There is significant difference in group B as regard to peripheral oxygen saturation (SpO2) and Systolic blood pressure (P <0.001 and 0.013 respectively).  VAS (median ± SD) was lesser in group A 4.16 ± 2.12 VS 4.96 ± 2.05 in group B. Pain intensity difference was significant decrease group A over time (P= 0.032). Requesting analgesia and rescue analgesia were insignificant different between two groups.

Conclusions: Both femoral nerve block and IV fentanyl are effective in relieving pain in patients with femur fractures. But femoral nerve block provides better and intense analgesia, and major pain intensity difference in less time. Moreover, use of FNB had fewer side effects and more hemodynamicsstability as compared to opioids.

Open Access Original Research Article

Knowledge and Adherence of Primary Health Care Physicians to Hypertension Management Guidelines in Family Health Facilities, Tanta Gharbia

Soad Foad Ahmad, Gamalat Mohammed Ali Elsaleet, Hanaa Abdelaziz Mohamed Zayed, Salwa Abd-elmageed Hassan Atlam

Journal of Advances in Medicine and Medical Research, Page 54-60
DOI: 10.9734/jammr/2022/v34i1331379

Background: Hypertension is a long-term condition in which the blood pressure in arteries is persistently elevated higher than 130 over 80 millimeters of mercury. Hypertension as an office systolic blood pressure and/or Diastolic Blood Pressure; which is equivalent to a 24-hours average ambulatory blood pressure management (AMBPM > 130/80 mmHg) or home blood pressure measurements (HBPM) average >135/85 mmHg.

Aim: To assess knowledge of physicians in the family health facilities in Tanta City, Gharbia Governorate regarding hypertension and its management, adherence of family physicians and to detect barriers which interfere with their adherence to the guidelines if any.

Methods: This is a cross sectional study. It was conducted in Family Health Units of the two main health administration sectors in Tanta City (The first administration sector includes16 units and the second one includes nine units) Tanta, Egypt. The target population of the study was all physicians working in Tanta Family Health Facilities (n=120). This study started from September 2019 and completed in June 2021.

Results: Out of physicians, 47 (39.2%) doctors read and implemented guidelines, 37 (30.8%) of physicians heard about it but never had a copy of guidelines and 36 (30%) of them had one but never read the content. More than two thirds 82 (68.3%) of physicians received training about the guidelines but only 68 (56.7%) used these guidelines for management of the patients. The highest percent of physicians had Fair knowledge level (67.5%) about guidelines. Regarding knowledge sub items, definition of guidelines followed by referral criteria and investigations had the highest rank of knowledge level among physicians while treatment, had the lowest rank level. The highest percent of physicians were partially adherent to guidelines (60%). Regarding adherence sub items, measurement of blood pressure followed by history taking had the highest rank among physicians followed by investigation, while treatment and clinical examination had the lowest rank.

Conclusion: PHC physicians were found to have a lack of awareness of specific HTN management guidelines as well as inadequately documented practise adherence.

Open Access Original Research Article

Sero-Epidemiology of Transfusion Transmissible Hepatitis B, C and E among Blood Donors in Ekiti, Southwestern Nigeria: A Cross-sectional Study

K. A. Fasakin, M. A. Muhibi, A. A. Ibijola, O. D. Ajayi, M. I. Onyema, Y. Obazee, A. A. Adeniyi, W. A. Ajetunmobi, I. O. Adebara, A. Adebayo, A. I. Okunlola, M. Yusuf, B. S. Awoyinka, O. A. Ajetunmobi, A. Bakare, O. T. Adeyemo, O. E. Adewara, N. Anyahara, C. E. Onyema, O. B. Bolaji, O. M. Ayankunle, O. P. Aduloju, E. O. Ogundare, A. O. Babatola, A. S. Adefisan, B. A. Olofinbiyi, Z. A. Jeremiah

Journal of Advances in Medicine and Medical Research, Page 61-72
DOI: 10.9734/jammr/2022/v34i1331380

Background: Transfusion transmissible hepatitis (TTH) is a global health problem and the incriminating agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis E virus (HEV) continue to pose serious threats to blood safety. The aim of this study was to determine the seroprevalence of HBV, HCV and HEV and relate the outcomes with blood donation type, age and gender and confirm any significant associations.

Materials and Methods: In this cross-sectional study, Hepatitis B surface antigen (HBsAg) and antibody to HCV were determined with Diaspot and Lab Acon immunochromatographic ELISA-based test devices. Antibodies to HEV were first determined with Biopanda lateral flow device followed by ELISA assay for sero-reactive HEV immunoglobulins M and immunoglobulin G (IgM and IgG) antibodies.

Results: A total of 370 prospective blood donors between 18 and 55 years old (mean 31.2 ± 7.6 years) who presented for blood donation at FETHI Blood Bank were screened. Overall male: female ratio was 7:1. Cummulative hepatitis seroprevalence of 8.1% was found mainly among the replacement blood donors (RBD) and consist of 4.3%, 1.6%, 1.1%, 0.8% and 0.3% serologic evidence of HBsAg, anti-HCV, HEV IgM, both HEV IgM & HEV IgG, and HEV IgG antibodies. Blood donors aged 18 – 45 years were most affected with evident significant association between the age group of donors and TTH seroprevalence. Cummulative hepatitis seroprevalence was 0% among voluntary blood donors, and 9.1% and 0.3% among the male and female RBD respectively. There was significant association between the pathogens and RBD, though the association with male gender was clinically but not statistically significant.

Conclusion: The high transfusion transmissible hepatitis seroprevalence among RBD called for promoting voluntary donations. Comparable prevalence of HEV antibodies with that of HCV called for its inclusion in the TTIs screening algorithm to ascertain optimal blood safety in Nigeria.

Open Access Original Research Article

Immunohistochemical Analysis of B-Cell Maturation Antigen (BCMA) as a Novel Marker in Correlation with Its Serum Level to Predict Multiple Myeloma Patients' Outcome

Nashwa Saad Mohammed Abdeen Sallam, Heba Ahmed Morad, Manal Abd El-Wahed Eid, Basma Mostafa El-Gamal, Hesham Ahmed Tawfik

Journal of Advances in Medicine and Medical Research, Page 73-85
DOI: 10.9734/jammr/2022/v34i1331381

Background: Multiple myeloma (MM) is a neoplastic disorder characterized by clonal proliferation of malignant plasma cells in the bone marrow (BM) producing monoclonal proteins and inducing specific organ and tissue damage. This study aimed to evaluate the expression and serum level of B cell maturation antigen (BCMA) and its prognostic value in newly diagnosed multiple myeloma patients.

Methods: This prospective study was carried out on 60 patients who were classified into two equal groups including group I (MM patients) which was newly diagnosed as MM and group II (healthy Control) which healthy individuals served as control.

Results: There was a statistically significant increase in MM patients than control group levels were increased in MM patients. Plasma cell percentage in BM aspiration was a statistically significant increase in MM patients. As regarding serum BCMA, there was a statistically significant increase in MM patients than the control group. There was a significantly positive correlation between serum BCMA and its surface expression with plasma cells in BM, CD138 expression in a biopsy, creatinine, B2 microglobulin, LDH, ESR, and total calcium. There was no correlation between BCMA level and age, hemoglobin, WBCs, and platelets count. Serum BCMA and BCMA expression showed a significant correlation with the clinical status of the patients' group, patients with complete response showed a lower level of serum BCMA and lower expression of surface BCMA and longer OS and DFS while patients with failure of CR relapsed group showed a higher level of serum BCMA and higher expression of surface BCMA and shorter OS and DFS.

Conclusions: Important role of BCMA expression and its serum level in the diagnosis of multiple myeloma, as the BCMA level in serum significantly elevated in MM patients compared with the control group. Moreover, serum BCMA level and its surface expression are positively correlated with plasma cell percentage in BM aspirate, CD 138 expression in BM biopsy, M protein, and B2 macroglobulin.

Open Access Original Research Article

Role of Magnetic Resonance Spectroscopy in Diagnosis of Developmental Delay in Children

Walaa Essam Ali, Ahmed Abd El-Basset Abo Eezz, Rasha Ahmed El Shafey, Atef Hammad Teama

Journal of Advances in Medicine and Medical Research, Page 86-92
DOI: 10.9734/jammr/2022/v34i1331382

Background: MR spectroscopy examines molecules like hydrogen ions and protons. The technique of proton spectroscopy is more commonly used. Metabolites, or metabolic products, come in a variety of forms. The aim of this work is to evaluate the role of MR spectroscopy in diagnosis of infants and children presented with developmental delay.

Methods: This study was carried out on 30 children presented with developmental delay aged between 3 months to 12 years referred for brain MR spectroscopy for diagnosis of delay in milestones. All patients were subjected to: Full history, clinical examination, some patients need I.Q testing and MRS assessment.

Results: There was no significant difference in N-acetyl-aspartate/creatine and Cho/Cr ratios in cases ≤ 2 years between the study group and the control group. N-acetyl aspartate/creatine ratio in cases >2 years was significantly lower in the study group patients than that of control   group P<0.05. Cho/Cr was significant increase in study group compared to control group (p< 0.05).

Conclusions: the proton MR spectroscopy can be used to diagnose and follow developmental delay especially in children more than two years as we found typical changes in NAA/Cr and Cho/Cr.

Open Access Review Article

A Narrative Review on Neuromyelitis Optica

Gabriel Alugba, Alexsandra Urhi, Gibson O. Anugwom, Samuel O. Ilikannu, Omotola Akinade, Oboseh J. Ogedegbe, Tioluwani K. Ojo, Ayodeji D. Johnson, Kingsley C. Nwadi

Journal of Advances in Medicine and Medical Research, Page 24-44
DOI: 10.9734/jammr/2022/v34i1331377

Neuromyelitis Optica, also known as Devic's disease, is a central nervous system (CNS) autoimmune inflammatory disease that primarily affects the optic nerve and spinal cord. The mechanism of the disease is given by the generation of IgG antibodies, whose major target is the aquaporin channel 4 (AQP4), causing an inflammatory and demyelinating process in the aforementioned tissues. In this study, we discussed extensively this disease entity by describing the epidemiology, pathogenesis, clinical features, management, and prognosis.