##### Efficacy of Hysteroscopy in Management of Premenopausal Uterine Bleeding at Tanta University Hospitals

Dina Hegazy Mohamed Hegazy, Shereef Lotfy Elshwaikh, Hassan Tahsin Shoeir, Ahmed Hussein Abou Freikha

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2022/v34i1831419

Background: Hysteroscopy is a minimally invasive procedure that may be used to analyse data and treat a variety of intrauterine and endocervical issues. The purpose of this work was to evaluate the hysteroscopic diagnostic findings and therapeutic efficacy of hysteroscopy in females with premenopausal uterine bleeding at Tanta University Hospitals.

Methods: This was a prospective cohort observational research enrolled 60 premenopausal females aged from 40 to 52 years and presented with abnormal uterine bleeding. All patients were subjugated full history taking, clinical examination (general examination, pelvic examination and abdominal examination) and investigations (laboratory tests including full blood count, thyroid, iron studies, hemostasis disorders, transvaginal ultrasound to evaluate any organic lesion and hysteroscopy).

Results: The success rate of hysteroscope was 100% in in grade I fibroid uterus and was 30% and 0% in grade II and grade III fibroid uterus. 75% of atrophic endometrium, 71% of secretory endometrium, 50% of proliferative endometrium, 100% of hyperplastic endometrium and 100% of endometrial polyp.

Conclusions: The gold standard for diagnosing and treating abnormal uterine bleeding is hysteroscopy in the premenopausal period especially of fibroid uterus and endometrial polyp.

##### Comparative Study of Serum Ferritin with C - reactive protein Serum Adenosine Deaminase, and Other Biochemical Parameters in COVID-19 Patients

Vinita Belsare, Hrishikesh Belsare, Sanjay Agrawal, Sarika Munghate

Journal of Advances in Medicine and Medical Research, Page 9-18
DOI: 10.9734/jammr/2022/v34i1831420

In COVID-19 pandemic clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact these components of patient care. COVID-19 is not a localized respiratory infection but a multisystem disease caused by a diffuse systemic process involving a complex interplay of the immunological, inflammatory and coagulative cascades. The understanding of what the virus does to the body and how the body reacts to it has uncovered a gamut of potential biomarkers. Our study demonstrates the different classes of biomarkers – immunological, inflammatory, cardiac, biochemical in terms of their pathophysiological basis. The correlation of serum ferritin with CRP, ADA and biochemical parameters predicting cardiac injury, liver injury and renal injury were evaluated. Serum ferritin and CRP was found to be significantly elevated with the disease severity. Serum ADA levels were also significantly different in group with high ferritin, which demonstrate that increased ADA leads to low adenosine, which is further responsible for exaggeration of inflammatory response in Covid-19. This suggest the protective role of adenosine in COVID 19. CKMB and LDH also serves as important biomarkers for cardiac injury and was found to be significantly different in groups with high ferritin which also suggestive of myocardial damage. Hepatic and renal bio parameters were also significantly different in groups with high ferritin levels, which is also suggestive hepatic and renal damage.

##### Cerebroplacental Doppler Indices in Intrauterine Growth Restriction Fetuses before and after Maternal Dexamethasone Management

Mona A. Belal, Hesham M. Borg, Amr M. El-Badry, Ahmed M. Awara

Journal of Advances in Medicine and Medical Research, Page 19-31
DOI: 10.9734/jammr/2022/v34i1831422

Background: IUGR increases the risk for intrapartum asphyxia, preterm delivery, and risks associated with preterm delivery, including but not limited to respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Doppler ultrasound gives us information on the vascular resistance and, indirectly, on the blood flow. The aim of this work is to assess any change in the cerebroplacental Doppler ratio before and after receiving Dexamethasone on pregnancies complicated by fetal growth restriction.

Methods: A prospective study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University on 60 pregnant females after counseling and explaining of the procedure to patients, assurance of confidentiality, anonymity and their acceptance.

Results: The mean GA was 32 weeks and mean weigh of the fetus was 1165 kg with mean amniotic fluid index 5.85 cm. There was significant increase in MCA PI after treatment p-value <0.001. there was significant decrease in UMA PI after treatment with p-value <0.001.

Conclusions: Dexamethasone use in cases of IUGR is associated with significant improvement in the form of decrease in umbilical artery S/D ratio and pulsatility index.

##### Prevalence and Associated Risk Factors of Oral Mucosal Lesions and Orofacial Dyskinesia in Patients with Psychotic Disorders

Journal of Advances in Medicine and Medical Research, Page 32-42
DOI: 10.9734/jammr/2022/v34i1831423

Aim: To determine the prevalence of oral mucosa lesions, facial movement disorders and the associated risk factors among patients with psychotic disorders and controls.

Study Design: A cross sectional study

Place and Duration of Study: The department of mental health and the General outpatients’ clinic   of the Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife, Nigeria. between October 2016 to November 2017.

Methodology: One hundred and eighty consenting patients (90 cases and 90 controls) were recruited. Oral mucosa assessment was based on W.H.O guide to epidemiology and diagnosis of oral mucosa diseases. Involuntary facial movement was assessed using the Abnormal Involuntary Movement Scale. Xerostomia assessment was done by volumetric sialometry.

Results: Prevalence of oral mucosa lesions in patients with psychotic disorders was 83.33% while it was 71.11% for the controls (P=0.05). The likelihood of developing oral mucosa lesions in patients with psychotic disorders increased with age (Odds ratio 1.02, 95% C.I (1.00-1.03), P=0.04). Orofacial dyskinesia was observed in 17 (18.89%) of the cases on antipsychotic medications and none in the controls (P<0.001).  The risk of developing orofacial dyskinesia also increased (Odds Ratio 1.096, 95% C.I (1.03-1.16), P=0.003) with increase in age in the cases.

Conclusion: Oral mucosa lesions and orofacial dyskinesia were more prevalent in patients with psychotic disorders than the controls. Increasing age was a risk factor for developing oral mucosa lesions and orofacial dyskinesia among patients with psychotic disorders.

##### A Comparative Study on Influence of Epidural Volume Extension on the Block Characteristics of Subarachnoid Plain Bupivacaine for Lower Abdominal Surgeries

Vernatius Chibueze Aniobi, Longinus Ndubuisi Ebirim, Maxwell Tobin

Journal of Advances in Medicine and Medical Research, Page 43-54
DOI: 10.9734/jammr/2022/v34i1831424

Background: Central neuraxial block is a common anaesthetic technique for lower abdominal surgeries. Epidural volume extension is a technique that involves the injection of saline into the epidural space immediately following intrathecal injection, after the institution of combined spinal-epidural anaesthesia.  This technique has some advantages over general anaesthesia like a circumvention of laryngeal response to airway manipulation. It also provides an effective sensory and motor blockade. The aim of this study was to assess the influence of epidural volume extension on the block characteristics of subarachnoid plain bupivacaine administered for lower abdominal surgeries.

Results: All the forty-two patients recruited completed the study. The mean time to request for the first analgesia was significantly longer in group Subarachnoid plus Epidural volume extension (SEVE) (208.63 + 84.14 minutes) than in group Subarachnoid (S) (148.95 ± 40.55 minutes), P= 0.02.  The maximum median level of sensory block was significantly higher in the Subarachnoid plus Epidural volume extension (SEVE) group compared with the Subarachnoid (S)  group and this was recorded at the 8th minute; T4 (T4-T6), and T5 (T5-T7), respectively. (P=0.01).  The mean time to reach T6 sensory level was significantly less in group Subarachnoid plus Epidural volume extension (SEVE); 6.00 + 1.80 minutes compared with group Subarachnoid (S); 7.00 + 1.10minutes. (P=0.04). The systolic and diastolic blood pressure, mean arterial pressure, pulse rate and peripheral oxygen saturation recorded during the duration of surgery was within normal limits in both Subarachnoid (S)  and  Subarachnoid plus Epidural volume extension (SEVE)groups. There was no statistically significant difference between the two groups. The side effects recorded were hypotension and shivering. Hypotension occurred in 19.0% of patients in both groups, while shivering occurred in 9.5% in group Subarachnoid plus Epidural volume extension (SEVE) and 4.8% in group Subarachnoid (S) (P=0.575).

Conclusion:  This study showed that epidural volume extension when using intrathecal low dose plain bupivacaine for lower abdominal surgeries not only provided adequate sensory and motor block but also a prolongation of anaesthesia. The incidences of side effects noticed in both groups were low and similar. Therefore, this study underscores the relevance of epidural volume extension on the subarachnoid block characteristics.

##### Significance of Serum Relaxin in Diabetic and Non-Diabetic Patients with Chronic Kidney Disease

Eman A. Elashmoney, Nashwa M. El-Gharbawy, Hossam A. Hodeib, Mousa M. Al-Naggar

Journal of Advances in Medicine and Medical Research, Page 55-67
DOI: 10.9734/jammr/2022/v34i1831426

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. The aim of the work is to evaluate significance of serum relaxin in diabetic and non-diabetic patients with chronic kidney disease. 60 subjects aged from (18years to 60 years) in internal medicine department at Tanta University hospital (outpatient –inward). This study was carried out from between March 2020 to March 2021. There was insignificant difference between groups according to age There was an inverse significant correlation between serum relaxin level and HBA1C in group 2 .but not in group 3. There was an inverse significant correlation between serum relaxin level and creatinine in group 2 .and in group 3. the best cut of level of relaxin hormone in discriminating normal individuals fron CKD patients was 150 ng/dl with an area under the curve(AUC) of 0,988 yeilding sensitivity of 93%, specifity of 95% , positive predictive value (PPV) 97%, negative predictive value(NPV) 86% and accuracy of 93%. Serum RLX levels are significantly lower in patients with CKD than healthy subjects. Furthermore, when compared to non-diabetic patients, they are much lower in diabetic patients. This research suggests that RLX could be a useful therapeutic option for diabetic nephropathy patients with developed fibrosis. RLX has a high safety profile, with potentially fewer adverse effects than conventional treatments because it is a naturally occurring physiological hormone. However, further effort is required.

##### Utility of Platelet Derived Microparticles in Predicting Complications of Diabetes Mellitus

Kaninika Sanyal, Shagun Wadhwa, Mrinalini Kotru, Richa Gupta, Alpana Raizada, Rajesh Pathak

Journal of Advances in Medicine and Medical Research, Page 68-77
DOI: 10.9734/jammr/2022/v34i1831427

Background: The long term complications related to DM are the main cause of mortality and morbidity in DM. However, many of the Diabetes related complications are detected later at end stage. Thus, there is a need for early diagnosis of the complications and biomarker that predicts the outcome of the disease and its complications. PMPs are the recent particles of interest that play a major role in pathophysiology of the disease and can be used to detect complications earlier.

Aim: To study the role of PMPs in DM

Objectives: To compare the levels of PMPs in adults who are Diabetics and in complicated diabetes

Material and Methods: A prospective case control study was done in Department of Pathology and Department of Medicine. 30 Diabetic patients were taken as cases while 30 healthy adults were taken as controls. Complete hematological profile was done for both the groups. Immunophenotyping using antibodies like CD45, CD41, CD61 and Annexin V+ was used to distinguish PMPs from platelets. The annexin V + particles were identified first and separately gated which were then observed in the CD41 vs CD 61 plots. The particles that were annexin V +, CD41+, CD 61+ were taken as PMPs.

Results: There was significant difference between Hemoglobin, total leucocyte count, platelet count and Annexin V between cases and controls as p< 0.05. PMPs ranged from 2± 169 with a mean ± SD 53.7 ±57.49 in controls and from 36 ± 2256 with a mean ± SD 574.50 ±647.98 in diabetic cases while PMPs in the complicated diabetes group was from 848.42± 810.51 (78-2264). Thus, higher levels of PMPs were seen in Diabetes and Diabetic complications and the difference was statistically significant.

Conclusion: Thus, this study shows that there is an increase in the levels of PMPs in DM and its complications and thus can play a role in the thrombotic state of the disease as well as can give rise to various DM related complications.

##### Hysteroscopy versus Three-dimensional Transvaginal Ultrasonography for the Detection of Endometrial Cavity Abnormalities

Yasmin Gamal Sakr, Mohamed Mohsen Elnamoury, Hesham Mohamed Borg, Diaa Mounir Aglan

Journal of Advances in Medicine and Medical Research, Page 78-84
DOI: 10.9734/jammr/2022/v34i1831428

Background: Three-dimensional sonographic technology has gained increased acceptance in clinical practice. This technique involves the gathering of a large amount of data and the quick reconstruction of pictures in the coronal, sagittal and transverse planes. The purpose of this work was to compare the diagnostic accuracy of the three-dimensional trans vaginal ultra-sonographic (3-DTVUS) and hysteroscopy in the detection of cavitary lesions in the uterus.

Methods: This study was comparative cross-sectional and included 60 patients who had 2D ultrasonography or hysterosalpingography for suspected intrauterine abnormalities. Each patient underwent a thorough history taking, clinical assessment, investigations, imaging [2D transvaginal ultrasound and 3D vaginal ultrasound] and hysteroscopy.

Results: 3DTVUS had a (95%) sensitivity in detecting uterine abnormalities compared to hysteroscopic examination. Also, the specificity was (88%) which indicates that only (12%) of the truly negative cases will be missed. The positive predictive values (PPV) of 3D TVUS were (99%) with an accuracy of (94%). The lowest parameter calculated was the negative predictive value (NPV) (58%). 3DTVUS had a specificity and PPV of 100% regarding the detection of all of the mentioned uterine abnormalities. Furthermore, the sensitivity was 100% for all abnormalities except the polyps and adhesions which were 91% and 67% respectively. The NPV was 100% for all abnormalities except for the polys and intrauterine adhesions (IUAs) which recorded 97%. Finally, the accuracy of 3DTVUS in comparison to hysteroscopy was 100% for all intrauterine abnormalities except the polyps and IUAS which were 98% and 97% respectively.

Conclusions: 3DTVUS can be utilized in diagnosing focal lesions of the uterus with comparable outcomes to hysteroscopy.

##### Evaluation of Results of Internal Fixation of Base Fifth Metatarsal Fractures

Hesham Gamal Motawea, Ali Mahmoud Emran, Ahmed Elsayed Eltantawy, Moheb Eldeen Ahmed Fadel

Journal of Advances in Medicine and Medical Research, Page 85-92
DOI: 10.9734/jammr/2022/v34i1831432

Background: The fifth metatarsal base fracture is a quite frequent fracture, occurring at a rate of 6 per 100,000 yearly. Fractures of the metaphyseal-diaphyseal junction (Jones fractures) have a higher rate of non-union and occasionally do require surgery. This research aimed to assess the findings of surgical treatment of a recent fracture base of 5th metatarsal in adults’ zone II, III by percutaneous intramedullary cannulated cancellous screws (4 mm and 6.5mm).

Methods: This prospective case series research was involved 21 adult patients with recent trauma and closed base of 5th metatarsal fractures. All participants were subjected to laboratory study, methods of radiological evaluation [Antero-posterior aspect of the foot, oblique aspect of the foot].

Results: AOFAS score was significantly different among age groups at 2 months and insignificantly different at 6 months. AOFAS score was insignificantly different between both sexes.

Conclusions: Percutaneous intramedullary cannulated cancellous screws fixation of base 5th metatarsal fractures with a cannulated cancellous screw 4mm,6.5mm has a high union rate (100%) with early mobilization and return to work and daily activity without need to do below knee cast or slab, so it decreases post cast stiffness rate. It also increases rate of union and healing by doing compression of the fracture site using the cannulated cancellous screw and keeping hematoma without evacuation. Using of larger screws in diameter like 6.5 mm to be fit in the medulla, is more beneficial than 4 mm screws.

##### Progranulin/Tumor Necrosis Factor-$$\alpha$$ ratio in Psoriasis Vulgaris

Hoda S. Sheir, Enayat A. Badr, Abeer A. Hodeib, Mohammed K. Zahra

Journal of Advances in Medicine and Medical Research, Page 93-99
DOI: 10.9734/jammr/2022/v34i1831433

Background and Aim: In psoriasis, the proteins Tumor Necrosis Factor (TNF) and interleukin-6 (IL-6) are overexpressed and play important roles in the disease's progression. For treating psoriasis, biological drugs that target TNF signaling are quite successful. Embryogenesis, tissue repair, cancer, neuronal survival, host defense, and inflammation are all dependent on progranulin (PGRN). By competing with TNF binding to TNFR1/2, PGRN inhibits TNF-mediated signaling pathways and has anti-inflammatory properties in inflammatory arthritis models. The current research seeks to study the relationship between serum PGRN / TNF - $$\alpha$$and psoriasis vulgaris activity.

Subjects & Methods: This study’s subjects were categorized into 2 groups: group 1 with 35 patients with psoriasis vulgaris, and group 2 of 30 healthy subjects with matched age and sex.

Results: We discovered a significant increase in PGRN and TNF-$$\alpha$$in cases versus control. And we have found a significant decrease in PGRN/TNF-$$\alpha$$ratio in cases versus control. We also detected significant differences between the Psoriasis Area Severity Index (PASI) degree and the levels of PGRN and TNF-$$\alpha$$, as well as the PGRN/TNF-$$\alpha$$ratio. We discovered a negative significant correlation between PASI and PGRN/TNF-$$\alpha$$ratio.

Conclusion: Atsttrin exhibited potent anti-inflammatory properties due to its three modified granulin motifs and their associated linker regions. In the treatment of rheumatoid arthritis and contact dermatitis, PGRN and its derivative Atsttrin may be a potential therapeutic drug.