Open Access Case Report

Bilateral Ovarian Dermoid Cysts with Persistent Anemia and Thrombocytopenia in an Adult Female: A Rare Case Report

Nidhi Chaturvedi, Neema Tiwari, Rani Bansal

Journal of Advances in Medicine and Medical Research, Page 64-67
DOI: 10.9734/jammr/2022/v34i1431389

Autoimmune phenomena are commonly encountered in the female population either as the primary disease or in association with conditions like pregnancy or as a part of paraneoplastic syndromes. Exact pathogenesis of such immune reactions may be clearly defined in cases like Grave’s disease, SLE etc or may be secondary to unexplained phenomena .These patients however may manifest as hematological symptoms like anemia and thrombocytopenia, skin manifestations or co existing thyroid issues .Tumors commonly present with autoimmune paraneoplastic syndromes. These can be non-hematological and hematological. Common hematological manifestations we encounter are either ITP or autoimmune hemolytic anemias. Ovarian tumors rarely occur with autoimmune features. There have been documented cases of bilateral dermoid cyst with associated Immune thrombocytopenia (ITP) as well as autoimmune hematological anemias in recent literature. Here we discuss a case of a 26-year-old female with bilateral ovarian dermoid cyst, who presented with transfusion dependent anemia and thrombocytopenia. Her anemia responded to immunosuppression therapy but thrombocytopenia responded to lesser extent.

Open Access Original Research Article

Study the Role of Pro-Inflammatory Cytokines (Interleukin 1-Beta, Interleukin 6) and High Sensitivity C-reactive protein in Children with Refractory Epilepsy

Dalia Mohammed El-Kammah, Hisham Ahmed El-Srogy, Tarek Mohammed El-Gohary, Sahar Abdel-Azim Abdel-Aziz

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2022/v34i1431383

Background: The International League Against Epilepsy (ILAE) has defined epilepsy as a condition in which at least two unprovoked (or reflex) seizures happening for more than 24 hours part, or it can involve one unprovoked seizure if there is a recurrence possibility over the subsequent 10 years, or if the patient has been diagnosed with epilepsy syndrome. A failure of seizures controlling with at least 2 or more antiepileptic drugs for at least 2 years with good compliance and adequate serum therapeutic drug levels with a minimum frequency of seizures with no more than 3 months of free seizures is the definition of refractory epilepsy.

Methods: This case control research was conducted on 130 children selected from the outpatient clinic of pediatric neurology. They were divided into three groups: group I with refractory epilepsy, group II with controlled idiopathic epilepsy and group III were healthy children. All children enrolled in the study were subjected to the following: routine laboratory investigations (serum antiepileptic drugs, complete blood count and liver and renal function tests) and specific laboratory investigations (estimation of serum interleukin-6, IL-1β and hs-CRP) electroencephalography (EEG), brain magnetic resonance imaging (MRI).

Results: Interleukin -6, interleukin -1 beta and high sensitivity C-reactive protein serum levels were significantly higher in refractory epilepsy children, than in those with controlled epilepsy and the control children (P<0.001). IL-6, IL-1β and hs-CRP serum levels showed no significant difference in children with controlled epilepsy in comparison to healthy control children (P>0.05).

Conclusions: The production of IL-1β, IL-6 and hs-CRP has been increased in the serum of refractory epilepsy children. Our findings suggest that this systemic inflammatory reaction with increasing IL-6, IL-1β and hs-CRP mean serum levels are effective biomarkers for epileptogenesis in the children and may contribute to refractory epilepsy and potentially can be correlated with the severity and prognosis of the disease.

Open Access Original Research Article

Clinical Significance of Haematologic Indices as Indicators for Systemic Lupus Erythematosus Activity

Samar Darwish Mostafa Alhelby, Hossam AbdElmohsen Hodeib, Amr Mohamed Gawaly, Ebaa Hussein El-Sheikh

Journal of Advances in Medicine and Medical Research, Page 16-30
DOI: 10.9734/jammr/2022/v34i1431385

Background: Lupus erythematosus is a diverse autoimmune disorder that is capable of afflicting a variety of organs and has a clinical history that is inconsistent. Despite substantial improvements in systemic lupus erythematosus (SLE) patient survival, the pathophysiology of the disease remains unexplained, despite the fact that genes play a key role in its propensity.

Objective: To evaluate the several hematological indicators (neutrophil- to- lymphocyte ratio (NLR), platelet -to- lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV) in SLE patients and their correlation with disease manifestations.

Patients and Methods: In our study, a cross-sectional comparative study that enrolled 100 SLE patients (30 male and 70 female patients) aged from 18-55y who are recruited from the Internal Medicine Department, Rheumatology Unit (inpatient wards and outpatient clinics) the patients were categorized into three groups according to the (SLE disease activity index 2000. (SLEDAI-2K): Group (I): Inactive (SLEDAI-2K, <6) Include thirty-one patients. Group (II): Moderately active (SLEDAI-2K, 6-10) Include twenty-nine patients. Group (III):  Highly active (SLEDAI-2k, ≥11) Include forty patients.

Results: Our study showed clinical parameters such as vasculitis, nephritis, serositis, CNS involvement are significant and indicate severe activity. Also, our study showed laboratory data as ESR, ANA, anti-dsDNA, and consumption of complement showed a significant correlation with systemic lupus activity. The highly active group had higher PLR, NLR, PDW, and MPV than other groups. However, the highly active group showed a decrease in lymphocyte median. CNS symptoms indicated a negative correlation that is statistically significant with lymphocytes. While it demonstrated a statistically significant positive correlation, with NLR, however, CNS showed a significant positive correlation with PDW. Nephritis had a significant positive correlation with NLR and PLR. Vasculitis had a positive highly significant correlation with lymphocytes and a positive significant correlation with PLR.

Conclusion: Patients with SLE in both high and moderate activity of disease exhibited significant renal manifestations, vasculitis, serositis, CNS symptoms, consumed C3 and C4 while ESR and Anti-dsDNA were elevated in all groups. The highly active group had higher NLR, PLR, PDW, and MPV than other groups. However, it showed a decrease in lymphocyte median. Further, CNS symptoms revealed a negative correlation that is statistically significant with lymphocytes, while it showed a positive statistically significant correlation with PDW and NLR. Nephritis had a positive significant correlation with NLR, and PLR and vasculitis had a positive highly significant correlation with lymphocytes and PLR.

Open Access Original Research Article

Histopathological Spectrum in Whipple’s Resection Specimens – a Six Years Retrospective Study in a Tertiary Care Centre

Zeenat Sarmadi Imam, Shadan Rabab, Reecha Singh, Bipin Kumar, Manish Mandal, Rakesh Kumar Singh, Md. Zeeshan Haider

Journal of Advances in Medicine and Medical Research, Page 31-47
DOI: 10.9734/jammr/2022/v34i1431386

Aims and Objectives: To study the demographic distribution and histomorphological variations of Whipple’s pancreaticoduodenectomy specimens in regard to tumour site, size, type, grade, marginal status, lymph node metastasis, perineural invasion (PNI) and lymphovascular invasion (LVI). This study will also highlight the incidental pathological lesions occurring in Whipple’s specimens. Hence it will further facilitate to analyse the prognostic significance of all these parameters in order to co-relate the overall spectrum of these cases.

Study Design and Place of Study: An observational retrospective time bound descriptive study conducted at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna after approval of ethical committee.

Materials and Methods: A total of 150 Whipple’s resection specimens received in the Department of Pathology, IGIMS, Patna from January 2015 to December 2020 were selected as per inclusion and exclusion criterias. Details were collected from histopathology request forms and hospital record sheets. Gross and microscopic features were analysed and recorded. Slides were reviewed and the parameters were calculated.

Results: Statistical analysis showed that out of 150 Whipple’s pancreaticoduodenectomy specimens, 141 (94%) cases were malignant tumours, 6(4%) cases had low malignant potential and 3 (2%) cases were of benign nature. Periampullary carcinomas were the predominant malignant tumours (78.66%), followed by ampullary carcinomas (14%) and pancreatic endocrine tumours (1.33%). Tumours with low malignant potential were constituted by SPN (solid pseudopapillary neoplasm of the pancreas) (2.67%), GIST (gastrointestinal stromal tumours) (0.67%) and mucinous cystic neoplasm of the pancreas (0.67%). Mean age incidence was 49.57 years with a male to female sex ratio of 1.4:1. Most of the malignant tumours (more than 75%) were moderately differentiated and were in stage 2 category. Out of the total 141 malignant tumours, 71 (50.35%) cases showed LVI, 50 (35.46%) cases had PNI and 84 (81.67%) had tumour deposits in the lymph nodes.

Conclusions: Our study emphasizes the importance of tumour grade, tumour stage, presence of LVI, PNI, positive margins and lymph node metastasis as strong prognostic factors for patient survival. This is well corroborated by the significant P value in our study. Most of our cases were diagnosed at a locally advanced stage. Hence a more precise assessment and clinical evaluation can lead to early detection of cancer, improving the survival rates.

Open Access Original Research Article

Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Thoracic Paravertebral Block for Pain Relief in Patients with Multiple Fractured Ribs

Hend Ahmed Ghoneem, Mohamed Elsayed Afandy, Ahmed Ali Abdel Hafez, Yasser Mohammed Amr

Journal of Advances in Medicine and Medical Research, Page 48-56
DOI: 10.9734/jammr/2022/v34i1431387

Background: Patients with rib fractures or chest contusions are unable to cough or breathe deeply, which may lead to atelectasis and pneumonia. And the cornerstone of management of rib fractures is aggressive treatment of this pain. Ultrasound guided (US) regional techniques was linked with fewer adverse effects and higher efficacy if compared with systemic therapy with multiple rib fractures. We designed this work for comparing the efficacy and safety of thoracic paravertebral block (TPVB) versus erector spinae plane block (ESPB) in cases with multiple fractured ribs.

Methods: This is a double-blinded prospective randomized controlled trial which was conducted on 60 patients aged ≥ 18 years of both sexes. The participants had unilateral multiple fractured ribs (≥ 3 ribs), and they were randomly enrolled into two equal groups. Group I had US guided TPVB. Bupivacaine 0.25% in a volume of 20 mL was injected in a bolus dose, then a continuous infusion of bupivacaine 0.25% at a rate of 0.1 mL/kg/hr. Group II received (US) guided ESPB. Bupivacaine 0.25% in a volume of 20 mL was injected in a bolus dose and then suspected to a continuous infusion of bupivacaine 0.25% at a rate of 0.1 mL/kg/hr.

Results: Visual analogue score (VAS) decreased significantly after institution of blocks (p-value <0.05) without considerable difference between two groups (P >0.05). And total morphine consumption was insignificant between two groups (P =0.836). Also, heart rate (HR) and mean arterial blood pressure (MAP) decreased significantly compared to pre-block values in both groups with an insignificant difference between the two groups (P >0.05). Moreover, respiratory, and arterial blood gases (ABG) parameters improved significantly in both groups in the form of reduced in respiratory rate (RR), elevated oxygen saturation, and increase in P/F ratio with an insignificant difference between the two groups (P >0.05). Occurrence of complications as hypotension, bradycardia and pneumothorax was less in ESPB group than TPVB group.

Conclusions: ESPB is nearly effective as TPVB to relief pain in cases with rib fractures as demonstrated by significant decrease in VAS scores in both groups.

Open Access Original Research Article

Evaluation of Cardiovascular Risk Markers in Hypertensive Pregnant Women

Tomaziga Tomiloba Oladapo-Akinfolarin, Oladapo Mayowa Akinfolarin, Stella Urekweru Ken-Ezihuo, Ebirien-Agana Samuel Bartimaeus

Journal of Advances in Medicine and Medical Research, Page 57-63
DOI: 10.9734/jammr/2022/v34i1431388

Background: In developed countries, heart disease and stroke are the major causes of death. One of the main risk factors of cardiovascular disease is dyslipidemia, and this could be due to increased lipoproteins and/or decreased plasma clearance. Pregnancy is marked with changes in metabolism in preparation for the developing fetus and lactation after delivery. Pregnancy causes long-term metabolic and vascular changes, which may raise the general risk of heart disease.

Aim: The goal of this study was to see how cardiovascular indicators changed during pregnancy in hypertensive pregnant women at Rivers State University Teaching Hospital.

Methodology: The study included 150 people who were divided into three groups: Non-pregnant hypertensive women (50), second trimester pregnant hypertensive women (50), and third trimester pregnant hypertensive women (50). After giving their consent, subjects were chosen using a simple random procedure. Total cholesterol (TC), high density lipoprotein (HDL), triglyceride (TG), low density lipoprotein  (LDL), very low density lipoprotein (VLDL), uric acid (UA), C-Reactive protein (CRP), apolipoprotein A1 (APoA1), and apolipoprotein B (APoB) were all measured in the lab using the venipuncture technique under fasting conditions (APoB).

Results: The findings revealed that there was a significant difference in each of the examined parameters (P<0.05) between hypertensive non-pregnant, 2nd trimester, and 3rd trimester hypertensive pregnant women, with the exception of HDL, TG, and VLDL (P>0.05).

Conclusion: This study has shown that hypertensive pregnant women are potential future candidates of cardiovascular disease.

Open Access Original Research Article

Phenotypic Detection of Extended-spectrum Beta-lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Hospital and Environmental Sources in Enugu Metropolis, Nigeria

Maduakor, Uzoamaka Charity, Okolie, Chidimma Deborah, Udoh, Iniekong Philip, Onyemelukwe, Ngozi Felicia

Journal of Advances in Medicine and Medical Research, Page 68-78
DOI: 10.9734/jammr/2022/v34i1431390


Background: Extended -Spectrum Beta- Lactamases (ESBLs) are enzymes that confer resistance to a wide range of β-lactam antibiotics, including penicillins, third-generation cephalosporins, and aztreonam, but not to cephamycins or carbapenems, and are blocked by beta-lactamase inhibitors.

Aim: To evaluate the antimicrobial susceptibility profiles of Escherichia coli and Klebsiella pneumoniae and to determine the prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from the hospital and environmental samples.

Methodology: The study was conducted from October 2020 to June 2021 in the Microbiological Laboratory of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. A total of 150 non-duplicate bacteria isolates were recovered from urine, wound swab, high vaginal swab, stool, sputum, and environmental sources. Isolates were identified and characterized using standard microbiological protocols. Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion procedure. Phenotypic detection of ESBL production was determined using Double Disc Synergy Tvest.

Results: E. coli isolates from hospital samples were highly resistant to cefuroxime (100 %), cefixime (100 %) augmentin (100%), ciprofloxacin (91%), and cefotaxime(86.6%). However, nitrofurantoin and imipenem were highly potent 80.6 % and 76.1% respectively. Among the 67 strains of E. coli from hospital samples, 32(47.8%) were found to be ESBL producers. Of the 60 Klebsiella pneumoniae hospital isolates tested, 27(45%) were found to be ESBL-producers. Of the 18 strains of E. coli from environmental isolates, 12(66.7%) were found to be ESBL producers. Out of only five Klebsiella pneumoniae from environmental samples tested, 4(80%) were found to be ESBL producers. A total prevalence of 75(50%) ESBL producers from the 150 isolates were found.

Conclusion: The findings of this study showed an alarming rate of 50% ESBL-producing E. coli and Klebsiella pneumoniae in Enugu Metropolis, Nigeria with a high antimicrobial resistance in both ESBL and non-ESBL-producing isolates.


Open Access Review Article

Current Concepts in Bio-minimal Endodontics: A Comprehensive Review on Modern Access Cavity Designs

Megha Rao, B. S. Keshava Prasad, H. Murali Rao, Vanamala Narayana

Journal of Advances in Medicine and Medical Research, Page 9-15
DOI: 10.9734/jammr/2022/v34i1431384

One of the most important steps in endodontic therapy is obtaining an adequate access to the root canal system. This ensures adequate instrumentation, irrigation, visibility, access and disinfection, making endodontic therapy more predictable. However, in the process of gaining a good convenience form, access cavities are being excessively widened, weakening the tooth to masticatory forces and increasing their chance of fracture. Clark and Khademi introduced evidence based new concepts of modern endodontic access designs which primary aims at preservation of tooth structure and increasing fracture resistance of the tooth. Several techniques of modern access designs have been proposed but they all correspond to one fundamental concept, bio-minimalism. This review aims to comprehensively summarize the principles of modern access cavity preparation as well as highlight the various techniques of modern access cavity designs.