##### Bronchogenic CYST: A Rare Case Report

Kamran Chaudhary, Manas Kamal Sen, Ruchi Sachdeva, Avinash Kumar, Swati Amrita

Journal of Advances in Medicine and Medical Research, Page 33-36
DOI: 10.9734/jammr/2022/v34i1931435

Bronchogenic cysts are rare congenital malformations which arise from abnormal budding of primitive tracheobronchial tube and can localize either in mediastinum or lung parenchyma. It may be called congenital if it is detected in early age group. Usually they are incidentally detected mediastinal masses. Bronchogenic cyst are asymptomatic in most adults. We present a case of 55 year old female complaining of chest pain, heaviness, dypnea and cough since last one year.

##### Congenital Complete Heart Block in Adults

Muneera Al Taweel, Sarah Al Mukhaylid, Nada Alsultan

Journal of Advances in Medicine and Medical Research, Page 245-248
DOI: 10.9734/jammr/2022/v34i1931458

Complete heart block occurs when atrial and ventricular contractions are not communicating, each beating, at their own pace. Therefore, it should be thoroughly investigated to ascertain its type. Congenital complete heart block (CCHB) might be unnoticed for a long time. CHB patients are prone to decreased perfusion related to symptoms of bradycardia and low cardiac output, which can lead to serious arrhythmias such as ventricular tachycardia, syncope, and sudden death. We searched PubMed and Google Scholar for CCHB in adults, implications, and outcomes. Accordingly further management of CHB is achieved by the implantation of a cardiac pacemaker, but it might be a challenging decision, particularly in asymptomatic patients.

##### Effects of Dextrose versus Corticosteroid Injection Guided by Ultrasound in Treatment of Lateral Epicondylitis

Marina Adel Hanen, Hanaa Samy Elbanna, Salwa Elmorsy Abd-Elghany, Elham Mohammad Kassem

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2022/v34i1931429

Background: One of the most common causes of elbow pain is lateral epicondylitis (LE). ultrasound (US) is diagnostic and therapeutic method.

Aim of the Work: The comparison between the effects of dextrose and corticosteroid injection guided by ultrasound in treatment of LE was the aim of this work.

Patients and Methods: This research was performed on 60 cases had chronic LE (local tenderness to palpation at lateral epicondyle and pain on resisted extension of middle finger or wrist) randomly classified into two equal groups depending on the treatment line, group A involved 30 cases subjected to2 injections of dextrose solution. Group B involved 30 cases treated by 2 injections with corticosteroid solution. Both groups were US guided. Patient evaluation at base line and after one month from last injection.

Results: In both groups, there was a significant improvement of the degree of tenderness, patient rated tennis elbow evaluation, visual analog scale and ultrasound changes, no significant improvement in group A more than group B.

Conclusion: Dextrose prolotherapy proved to be as effective as corticosteroid in chronic LE treatment.

##### Asymmetric Dimethylarginine Level in Children Undergoing Bone Marrow Transplantation

Dina Maher Ahmad, Eslam E. Elhawary, Gamal Alden Fathy, Hala Mohamed Nagy, Ibrahim Mohamed Bedraya, Mohamed Ramadan Elshanshory

Journal of Advances in Medicine and Medical Research, Page 10-14
DOI: 10.9734/jammr/2022/v34i1931430

Background: Asymmetric dimethylarginine (ADMA) is a toxic, non‐proteinogenic amino acids formed by post‐translational modification and is a uremic toxin that inhibits nitric oxide (NO) production. The aim of this work was to assess the serum level of asymmetric dimethylarginine in children underwent bone marrow transplantation.

Methods: This prospective, randomized controlled study has been conducted on 20 children aged 2-18 years underwent bone marrow transplantation (Group I) and 20 healthy control children of matched age and sex (group II).

Results: The serum level of ADMA was significantly higher after bone marrow transplantation (p value <0.05).

Conclusions: Elevated ADMA level after bone marrow transplantation indicates that endothelial dysfunction is a main complication in those patients.

##### Diffusion Weighted (DW) MRI in Correlation with Dynamic Contrast Enhanced MRI for Characterization of Ovarian Masses

Doaa Abbas Radwan, Fatma Anas Elshaarawy, Omnia Abd Elfattah Gad, Aly Aly Elbarbary

Journal of Advances in Medicine and Medical Research, Page 15-26
DOI: 10.9734/jammr/2022/v34i1931431

Background: Ovarian tumors; are the second most common gynecological tumor and in women
are the fifth commonest tumor. Preoperative differentiation between benign and malignant tumors is essential to decide whether surgery is required, and which type of surgery is appropriate avoiding unnecessary surgery. In addition to conventional imaging, dynamic contrast and diffusion weighted images can aid in the separation of benign from malignant ovarian tumors. DWI is based on the notion that water molecules can freely diffuse in a low-cellular environment, but tissue hypercellularity restricts this. As a result, unlike most benign tumors, malignant ovarian tumors have restricted diffusion due to their hypercellular structure. DCE-MRI depends on contrast agent leaking from capillaries into extravascular extracellular space to allow for quantitative ovarian lesions characterisation.

Aim of the Work: To evaluate the role of diffusion- weighted MR imaging correlated to dynamic contrast enhanced MRI in characterization of ovarian masses.

Patients and Methods: thirty female patients were included in this study. Who referred to the radiology department by ovarian masses. All patients underwent detailed history taking, laboratory investigations, Pelvic ultrasound examination and MRI examination with DWI and DCE MRI. The correlation was done between MRI findings and the final pathological diagnosis.

Results: The sensitivity of conventional MRI was 72.73% while that of DWI was 100%. The specificity was lower for DWI (57,89%) compared to conventional MRI (73.68%), The mean ADC values for malignant lesions were (0.91 x 10-3 ± 0.25 SD mm2/s), while that for benign lesions were (1.68 x 10-3 ± 0.65 SD mm2/s), with cut off 1.2 x 10-3. Mature teratomas and endometriomas showed restricted diffusion with low ADC values (false positive).

Sensitivity of conventional MRI was 72.73% while that of DCE-MRI was 90.91%. The specificity was higher for DCE 100% compared to conventional MRI sequences 72.73%, as well as the accuracy which was 73.33% for conventional MRI while that of DCE was 96.67% and so addition of DCE to the MRI is expected to increase the specificity

and the accuracy of examination.

Conclusion: Adding DWI and DCE to conventional MRI signifies: utilising a completely non-invasive procedure with no exposure to radiation. It enhances the specificity of MRI, hence enhancing the radiologist's confidence in image interpretation, which will ultimately affect the prognosis and outcome of patients.

##### Study of Serum Level of Interleukin 33 in Systemic Lupus Erythematosus Patients

Rana Gamal Saqr, Radwa Mahmoud Elsharaby, Abeer Abdelmenem Shahba, Sahar Mohey Eldin Hazzaa

Journal of Advances in Medicine and Medical Research, Page 27-32
DOI: 10.9734/jammr/2022/v34i1931434

Background: Systemic lupus erythematosus (SLE) is a chronic disease in which the immune system of the body attacks body tissues in multiple body systems, so it is called autoimmune disease. Arthritis, skin rash, photosensitivity, and nephritis are the most common clinical presentation in SLE. Interleukin 33 (IL-33) is one of the interleukins family, and it is established that IL-33 is central in inborn and acquired immunity. Historically, the IL-33 receptor was discovered first on the surface of T helper 2 cells and not T helper T1 cells.

Aim: Measuring Interleukin-33 level in serum of SLE patients and its relation to clinical presentation, activity, and severity of the disease.

Subjects and Methods: This study was conducted at Clinical Pathology and Internal Medicine Departments-Tanta University Hospital from March 2019 to December 2019 on 80 subjects

Results: The affected females were at the childbearing period, and the incidence among gender is higher for females than that for males, which reflects the hormonal role in SLE development. Serum creatinine, blood urea nitrogen, ESR levels were increased significantly in SLE patients than in the control group. There was a significant increase in serum IL-33 levels in SLE patients than control group indicating that IL-33 has a role in the pathogenesis of SLE. There was a significant difference in Hb, platelet count, ANA, and anti-ds-DNA between SLE patients and the control group. There was a significant positive correlation between IL-33 and serum creatinine, ESR, CRP, and SLEDAI. The most common feature was arthritis (88.3%) of patients, followed by skin rash (60.0%) of patients.

Conclusion: IL-33 levels in patients with SLE were significantly higher than that in the control group, and its level was significantly related to disease activity. This indicated that IL-33 has a role in the pathogenesis of SLE. So, IL-33 can be used as a diagnostic and a prognostic marker.

##### Percutaneous Release of Trigger Finger

Ahmed Samir Elfiky, Mohamed Abd El Hamed Romeih, Abdel Hafez Abd El Hafez Mougahed, Nabil Omar Gharbo

Journal of Advances in Medicine and Medical Research, Page 37-43
DOI: 10.9734/jammr/2022/v34i1931436

Background: Trigger finger (sometimes referred to as stenosing tenosynovitis) is a mechanical impingement of the hand's flexor tendon. This ailment is a frequent source of hand pain, discomfort, and impairment, since it may reduce the afflicted finger's range of motion. This research seeks to investigate the outcomes of surgical release of trigger finger by percutaneous method.

Methods: This prospective study that included 21 adult patients aged > 16 years and diagnosed by clinical assessment by percutaneous release of A1 pulley of the diseased finger with history of triggering for at least 3 months and failure of previous conservative treatments. Each case was followed up for 6 weeks after enrolment.

Results: Excellent outcomes were significantly increased in cases with one finger affection than cases with multi finger affection (P =0.025). There was no significant variance in the outcomes among patients with right and left sided hands. Patients with excellent outcome had shorter duration of symptoms than patients with good and poor outcomes (P =0.032).

Conclusions: Excellent outcomes were significantly increased in cases with office work than cases with manual work and in patients with one finger affection than patients with multi finger affection.

##### Comparison of Ultrasound Guided Thoracic Erector Spinae Plane, Thoracic Paravertebral and Thoracic Epidural Blocks for Pain Management after Nephrectomy

Saad A. Moharam, Amera M. Elkeblawy, Hesham M. Marouf, Thanaa M. Elnoamany

Journal of Advances in Medicine and Medical Research, Page 44-52
DOI: 10.9734/jammr/2022/v34i1931437

Background: Thoracic epidural and paravertebral blocks carry many risks and hazardous complications when performed for adequate pain management after nephrectomy. Therefore, we evaluated the efficacy and safety of Erector Spinae block (ESB) as an alternative block compared to thoracic paravertebral (TPVB) and epidural block (TEB) for pain management after nephrectomy.

Methods: This prospective randomized single-blinded controlled study was conducted on 105 adult patients undergoing elective nephrectomy. Patients were randomized into 3 groups (35 patients in each). Group I: ESB, group II: TPVB and group III TEB done at the same level and using the same LA mixture. Postoperative pain evaluated using visual analogue scale (VAS) meperidine (0.5 mg/kg) was given when VAS ≥ 4.

Results: Intraoperative hypotension and bradycardia were observed at 30 minutes (min) in group III with a significant difference when compared to other groups (P <0.001). Early first rescue analgesia & high analgesic consumption after surgery was noticed in group III.

Conclusion: US-guided thoracic ESB produced adequate analgesia for nephrectomy.

##### A Comparison of Postoperative Healing between Two Different Flaps for 3rd Molar Surgery in Controlled Diabetic Patients

Tamoghna Jana, R. Balakrishnan, Vijay Ebenezer

Journal of Advances in Medicine and Medical Research, Page 53-67
DOI: 10.9734/jammr/2022/v34i1931439

Background: A flap is a unit of tissue that is transferred from donor site to recipient site while maintaining its own blood supply. Flaps are of various shapes and forms. They can be simple advancements of skin and range up to composites of many different types of tissue. Diabetes Mellitus is a metabolic disease where there is significant elevation of blood glucose level from the normal range for prolonged periods of time. The common signs and symptoms are, frequent urination, increased thirst, increased appetite, lethargy, infections, delayed healing of wounds. The complications of surgical procedures on diabetic patients are: delayed healing, wound dehiscence and decreased immunity, thus increased incidence of infection in the surgical site. Complications of intra-oral surgical procedures include delayed healing, wound dehiscence, bone loss, periodontal derangement of teeth, infection, xerostomia causing more caries, failure of flap due to decreased vascularity.

Aims and Objectives: The study aimed to answer whether Envelope Flap is better than Triangular Flap or vice versa for a mandibular 3rd molar surgery. To examine the complications of choosing a specific flap design in a minor oral surgery in patients with higher susceptibility to infection due to systemic condition, which is controlled Diabetes Mellitus.

Materials and Methods: This study was conducted on 20 patients, who were taken from the out-patient of Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai. On one side which was picked randomly for all patients, the Triangular flap was used. On the other side, the Envelope flap was used.

Conclusion: The statistical analysis P value > 0.05, which shows that the difference in post operative healing between the two flaps discussed is statistically insignificant. Thus, statistically both flaps are a viable option and both show similar results, although clinically envelope flap shows better overall results.

##### Antibacterial Efficacy of Different Intracanal Irrigants on Root Canal Treatment: An In-Vitro Study

Sana Babar, Hina Ahmed, Abubakar Sheikh, Saqib Rashid, Tasleem Hosein, Hasan Mehdi

Journal of Advances in Medicine and Medical Research, Page 68-76
DOI: 10.9734/jammr/2022/v34i1931440

Aims: Out of many properties that an endodontic disinfecting agent should possess, the most important is that of having a wide range of antibacterial efficacy. This study has been performed to see the effect of different agents on the bacterial microflora and to see how efficient they are against them. Our study has used 3 different agents (Chlorohexidine, Sodium Hypochlorite, and Neem extract) and compared their efficacy against bacterial microflora.

Study Design: Experimental study design

Place and Duration: The study was conducted in the Department of Endodontics at Fatima Jinnah Dental College and Hospital, Karachi, Pakistan from February 2020 to March 2020.

Methodology: Infected samples from individuals were collected through paper points and then allowed to be cultured and incubated on blood agar plates at 37 degrees in an incubator for 24 hours. The colonies were then identified through the gram staining procedure and grown on MHA agar to conduct the disk diffusion test for sensitivity. Individual zones of inhibition for irrigants were measured and compared against each other.

Results: A total of 36 infected samples were included in the study out of which 12 samples were irrigated with chlorohexidine, 12 with sodium hypochlorite, and 12 with neem extract. there was a statistically significant difference in mean diameters of the inhibition zone observed between the three groups for the mean inhibition zone (F=12.28, P=0.001).

Conclusion: Chlorohexidine showed greater efficacy against bacterial microflora, compared to both sodium hypochlorite and neem extract.

##### Impact of Cosmobiological Factors on Chromosomal Anomalies Rates - Ethical Consideration

Danielius Serapinas, Andrius Narbekovas

Journal of Advances in Medicine and Medical Research, Page 77-82
DOI: 10.9734/jammr/2022/v34i1931441

Backround: In recent years, there is an increasing number of data supporting the relation between lunar cycle and alterations in human body. For instance, it has been proved that hospitalized spontaneous abortions are significantly associated with the lunar cycle . Given that the most common cause of spontaneous abortion is chromosomal abnormalities of the embryo, we presumed that the lunar cycle could influence the occurrence of chromosomal diseases. From the point of bioethics it is a question if it is applicable to talk with patients about possible impact of cosmobiological factors on their case of chromosomal anomaly.

Patients and Methods: We have selected 52 patients, who were bearing a fetus with a prenatally diagnosed chromosomal disorder, which included Down, Turner, Klinefelter, Patau and Edward syndromes. The control group (n=92) consisted of families, that were prenatally tested for chromosomal abnormalities and the results were negative. Then we gathered and analyzed information from patients' medical histories about various factors, which could have predisposed chromosomal disorders: age of both progenitors, consumption of medications during pregnancy, number of miscarriages, number of abortions, cases of genetic disorders in relatives, lunar phase on the day of conception.

Results: Lunar phases at the time of conception in the test group distributed as following: new Moon 32.7 percent, first quarter 25.0 percent, full Moon 28.8 percent, third quarter 13.5 percent. In the control group lunar phases distributed as following: new Moon 29.3 percent, first quarter 27.2 percent, full Moon 26.1 percent, third quarter 17.4 percent. There was observed no statistically significant difference between test and control groups (p>0.05). OR for conception with chromosomal anomalies were increased in July (2.7(CI 95% 1.5-4.9) and December (3.2 (CI 95% 1.5-5.2) (p<0.05). OR showed decreased risk for chromosomal anomalies during conception at January (0.3 (CI 95% 0.1-0.7) , April (0.5 (CI 95% 0.2-0.7) and June 0.5 (CI 95% 0.2-0.8) (p<0.05).

Conclusions: Our study showed there were no associations between lunar phase at the time of conception with the rates of chromosomal mutations. Conception in July and December increases the risk of chromosomal anomalies during conception. In contrast conception in January, April and June decreases chromosomal anomalies rates.

##### Verification of Fascial Fissure Direction at the Port-site: the Search for a Reliable Closure Method

Masahiro Kimura, Koshiro Harata, Ken Tsuboi, Yuzo Maeda, Seiichi Nakaya, Yoichi Matsuo, Akira Mitsui, Shuji Takiguchi

Journal of Advances in Medicine and Medical Research, Page 83-90
DOI: 10.9734/jammr/2022/v34i1931442

Background: One of the complications of endoscopic surgery is port-site hernia. The risk of port-site hernia is minimized by proper port-site closure, which relies on appropriate characterization of the fascia, particularly the direction of fascial fissures.

Methods: The following 4 procedures were examined to identify the fascial fissure direction: mobility of the port, observation from the lumen of the port, palpation for fascia, and visual confirmation. The match rate of each procedure with visual confirmation was verified.

Results: 51 port-sites without fasciotomy were examined. The direction of the fissure was from 12 to 6 o’clock in 11 cases and 3 to 9 o’clock in 40 cases. The match rate between mobility and the fissure was 45.1%. The match rate of observation from the lumen was 96.1%. Comparing the suturing time, the average time was significantly shortened to 327 seconds in the second half compared to 494 seconds in the first half of our study period with the VersaOneTM fascial closure system.

Conclusion: Treatment of port-site hernia can be done by suture or mesh repair, although ideally it is best to prevent the hernia in the first place. The fissure direction was almost always identifiable via observation from the lumen of the port. Closure of the port-site using modified Z-sutures allowed for full fascial closure, particularly in cases of patients with obesity.

##### Relationship of the Excessive placental Calcification and Amniotic Fluid Turbidity with Fetal Outcome in Normotensive and Preclamptic Pregnancies

Basma T. Mahmoued, Hosam A. Zyton, Ahmed M. Osman, Hesham M. Eltokhy

Journal of Advances in Medicine and Medical Research, Page 100-112
DOI: 10.9734/jammr/2022/v34i1931443

Background: However, the trigger for abnormal placental development and the subsequent cascade of events remains unknown.)Placental calcification often noted on ultrasound examination during pregnancy, is characterized by widespread deposition of calcium on the placenta, resulting in echogenic focithe aim of this study is to assess the relation  between excessive Placental calcification and amniotic fluid turbidity with fetal outcome in normotensive and preeclampsia woman.

Methods: Fifty pregnant women aged from 20 to 30 years old, classified into two groups (normotensive group & preecamptic group) each group involved 25 cases.

Results: there was 40% of preeclampsia had turbid amniotic fluid and only 8% of normotensive group had turbid amniotic fluid with no statistical difference in between (P= 0.188)

Conclusions: This study concluded that stair step regimen improves the ovulation rate and pregnancy rate without any detrimental side effects compared to traditional regimen. It helps to know the sensitivity and resistance of an individual to CC much earlier and helps to plan ahead with alternative treatment for desired outcome.

##### Progranulin/ Tumor Necrosis Factor-$$\alpha$$ Ratio in Rheumatoid Arthritis

Rabab Hamdy Mohamed, Enayat Ali Badr, Samy Abd-el-Kader Khoder, Mohamed Kamal Zahra

Journal of Advances in Medicine and Medical Research, Page 91-99
DOI: 10.9734/jammr/2022/v34i1931444

Background: Progranulin (PGRN) has significant functions in several processes, including immune response and the development of cancer. This study aims to research the relationship between the ratio of serum progranulin/tumor necrosis factor (TNF) alpha and the rheumatoid arthritis (RA) activity.

Methods: This study included 35 patients with rheumatoid arthritis whom we collected their complete history with personal and family history included in addition to 30 seemingly healthy individuals as a normal control group. In addition to clinical examinations, laboratory tests, and serum progranulin level and TNF-alpha by the Enzyme-linked Immunosorbent Assay (ELISA).

Results: There were significant increases in Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Rheumatoid Factor (RF), PGRN and TNF alpha in the diseased group compared to the control group. The serum levels of PGRN and TNF alpha in the rheumatoid arthritis community were significantly higher than in the control group. In the RA community, there was a positive association between the PGRN/TNF alpha ratio and Disease Activity Score in 28 joints (DAS28) score and RF. The relationship between PGRN and the severity ratio was significant. The relationship between TNF alpha and the severity ratio of the disease were highly significant. Also, a significant relationship between the PGRN/TNF alpha ratio and DAS28 score was significant.

Conclusion: An important correlation between circulating levels of PGRN and TNF-alpha, and activity of the disease was in RA patients.

##### Assessment of Primary Percutaneous Coronary Intervention Outcomes in Elderly and Very Elderly Patients

Sherif Seif, Mai Salama, Ayman Elsaeid, Aly Zaki, Seham Badr

Journal of Advances in Medicine and Medical Research, Page 113-124
DOI: 10.9734/jammr/2022/v34i1931445

Background: To date, data regarding safety and efficacy of primary percutaneous coronary intervention (P-PCI) in elderly patients are scarce. We aimed to assess the outcomes of P-PCI in the elderly subgroup, and to evaluate whether the advantages of P-PCI diminish with advanced ages.

Methods: This retrospective study included elderly patients who underwent P-PCI for acute STEMI. Patients were sub grouped according to their age into three groups (Group A: aged 75-84, Group B: aged ³85 and control Group C: aged 65-74). The primary endpoint was in-hospital and 30-day all-cause mortality, and secondary endpoints were MACE (death, stroke, MI or re-PCI), stroke, vascular complication, bleeding and transfusion, target vessel re-intervention, contrast induced acute kidney injury (CI-AKI) and gastrointestinal (GI) bleeding.

Results: A total of 1111 patients were included with 339 patients in group A, 95 patients in group B and 677 patients in the control group C. In terms of the primary endpoint of our study, no significant difference could be detected between the studied groups. CI-AKI was the only secondary outcome to show a significant difference (P =0.005). Arterial hypertension and a previous history of chronic kidney disease (CKD) were independent predictors of in-hospital mortality, with OR 5.336, 95% CI 1.187 – 23.998 and OR 11.024, 95% CI 2.104 – 57.756, respectively. Additionally, final TIMI flow less than 3 (OR 42.322, 95% CI 5.674 – 315.667) and bleeding that required blood transfusion (OR 87.144, 95% CI 3.086 – 2460.628) showed higher risk of in-hospital MACE.

Conclusion: our study revealed that outcomes of P-PCI for STEMI in elderly population (³75) are favourable and comparable to younger patients. Therefore, P-PCI should be offered to every elderly patient presenting with acute STEMI, after considering risk factors for mortality and MACE in this special age group.

##### Study to Identify the Prevalence and Predictive Factors of Post COVID Lung Fibrosis in COVID-19

R. K. Chopra, Mahavir Modi, Sneha Tirpude, Kaumudi Devi, Vishnu Gireesh, Abhijeet Lonsane, Aditya Pandya, Vaibhav Wankhede, Suyash Gandhe

Journal of Advances in Medicine and Medical Research, Page 125-134
DOI: 10.9734/jammr/2022/v34i1931446

Background: SARS CoV-2 has affected more than 494 millions of people all over across the globe till date. Most lethal infection of SARS-CoV-2 is highly representative of  patients suffering with idiopathic pulmonary fibrosis (IPF) [1]. Interstitial thickening, irregular interface, coarse reticular pattern, and parenchymal bands manifesting in the course of the disease might be predictors of pulmonary fibrosis in these  patients [2].

Objectives and Methods: Objective of the study is to identify the prevalence and   predictive factors of post covid lung fibrosis in covid-19 patients. The study was conducted in a retrospective manner and included 100 patients in our tertiary care center. HRCT thorax conducted in all patients were evaluated on admission, one month, 3 month and 6 months whereever indicated.

Results: The prevalence of post covid lung fibrosis was 2 % at 6 months , with CT severity score more for elderly male population. In our study we found a significant corelation between clinical severity and post covid fibrosis.

Conclusion: From our study, the post COVID lung changes are reversible, with only 2 % developing  the  post  covid lung fibrosis.

##### Relation between Vitamin D and Uterine Fibroid

Aml A. Hammad, Shereen B. Elbohoty, Sahar M. Hazzaa, Medhat S. Hewedy, Mohamed N. El-Gharib

Journal of Advances in Medicine and Medical Research, Page 135-146
DOI: 10.9734/jammr/2022/v34i1931447

Background: Uterine fibroids (UFs) are the most common benign tumors affecting women of reproductive age]. patients with uterine fibriod suffer from pelvic pain, menorrhagia, dysmenorrhea/dyspareunia, pressure-related symptoms, miscarriage, and subfertility. The aim of this study was to assess the relationship between occurrence, size, and clinical symptoms of uterine fibroid and the serum level of Vitamin D.

Methods: The study was designed as an observational case control study.

This study was conducted at Tanta University Maternity Hospital at the department of obstetric and Gynecology from March 2020 to September 2020.This study was conducted on 75 women in their reproductive age (20-45 yrs) recruited at Tanta obstetric and gynecology department                        (inpatient wards), they were subdivided into two groups:Group A: case group: 50 Women with uterine fibroid. Group B: control group: 25 Women with normal uterine examination and transvaginal ultrasound. Measuring the level of serum vitamin D3 in both control and women with uterine           fibroid.

Results: The age, in case group, ranged from 20-45 yrs with mean level 30.50± 4.56 yrs and in control group ranged from 20-45 with mean value 31.01+ 5.11 yrs. the diagnostic performance of vitamin D test in diagnosing uterine fibroid through illustrating sensitivity and specificity of vitamin D level to predict uterine fibroid. Area under the curve was 0.881with cut off value 14.3 ng/ml, the sensitivity of vitamin D to predict the fibroid was 79.3%, the specificity was 66.7 and test accuracy was 74.4%.

Conclusions: The current study showed a significant association between vitamin D3 deficiency in reproductive age women and the occurrence of uterine fibroid, the mean vitamin D3 level in the case group was 13.8±7.93 ng/ml and in the control group was 20.79+8.95 ng/ml.

• There is correlation between vitamin D3 level and the size of uterine fibroid.
• Vitamin D3 deficiency is widely spread among the study population with 80 % prevalence while vitamin D3 insufficiency is prevalent in 14% among study participants

##### Assessment of Dispensing Practice of Antibiotics in the Selected Community Pharmacies: A Prospective Study

K. V. Ramanath, M. S. Ashitha Gowda, Laasya Valleru, K. P. Parvathi, S. Revathi Patel

Journal of Advances in Medicine and Medical Research, Page 147-167
DOI: 10.9734/jammr/2022/v34i1931448

Introduction: Dispensing is the provision of drugs as set out correctly on a lawful prescription by the pharmacist/Healthcare professional doctor. The over-the-counter sale of antibiotics is a global problem. Antibiotics are very commonly prescribed and dispensed for patients in pharmacies, and it is increasingly recognized as antibiotic misuse. This misuse may increase the treatment cost and the development of antimicrobial resistance. Therefore, an assessment of dispensing patterns of antibiotics is essential to know the standard of pharmacy practice and prevent unnecessary antimicrobial resistance.

Objectives: To categorize the class of antibiotics used in the various diseases, check for the appropriateness of the antibiotics observed in the prescription, and understand the pattern of dispensing of antibiotics.

Methods: A community-based- a cross-sectional observational study was carried out for six months in Selected community pharmacies in Kumaraswamy Layout, Kengeri Bengaluru, Gubbi Tumkur District, Ballari Karnataka, SrikalahastiAndhra Pradesh. Document The information collected in the data collection form. PIL has been distributed to the study subjects. The data were analyzed using descriptive analysis.

Results: Among 26 pharmacy visits and 538 cases, 393(73%) were dispensed by D pharm graduates, 63(11.7%) BA graduates. 355(66%) were administered with a prescription, and 183 (34%) were dispensed without a prescription. The highly distributed brand was Spectratil (cefpodoxime) 46 (8.6%), Macrobid (Nitrofurantoin) 26(4.8%), Mahacef (cefixime) 24(4.4%) and Augmentin (Amoxycilin+Clavalunate) 18(3.4%), and the least dispensed brand was Q max (Ofloxacin) 1(0.2%), OFM (Ofloxacillin+Metrinidazole) 1(0/2%). Most of the antibiotics administered were for cough and fever i.e. 222 (41.3%) and toothache 85 (15.8%). Study subjects who had not heard about antibiotics were 461(85.7%), and 77(14.3) knew about antibiotics. 308(57.2%) said they could stop antibiotics after completing the course, and 193(35.9%) said antibiotics could be stopped when the patient felt better. Among 26 pharmacy visits, 440(81.8%) agreed that pharmacists should not dispense antibiotics without a valid prescription, and 344(64.9%) dispense antibiotics both by self-knowledge and request by the patient. 532(98.9%) know about schedule H1, and 512(95.2%) follow the Schedule H1 act. Among 538 study subjects, 406(75.5%) accepted the Patient information leaflet (PIL), whereas 122(22.7%) denied the PIL, and 10(1.9%) pharmacists did not permit us to distribute PIL.

Conclusion: The antibiotic class is majorly prescribed/dispensed as cephalosporins. 80 % of the registered pharmacists were presented in the community pharmacy dispensing activity. The legality of the prescription was 32%. Antibiotic appropriateness use must promotion by the community pharmacist is essential, so they must educate them. Physicians should charge minimal consultation fees, reduce the count of patients approaching the pharmacy without a prescription. In addition, continuous education to physicians and pharmacists to increase awareness about the emergence of antibiotic resistance plays a vital role in the society for proper use of antibiotics.

##### Study of Urinary Level of Vitamin D Binding Protein in Diabetic Nephropathy

Doaa El-Sayed Saad Moussa, Aalaa Mohamed Sweilam, Mohamed Sabry Aboelnasr, Wesam Salah Mohamed, Amal Said Elbendary

Journal of Advances in Medicine and Medical Research, Page 168-175
DOI: 10.9734/jammr/2022/v34i1931449

Background: Diabetic nephropathy is usually a clinical diagnosis made based on the presence of albuminuria and or reduced estimated glomerular filtration rate in the absence of signs or symptoms of other primary causes of kidney damage. The aim of this work was to study urinary level of vitamin D binding protein as an early predictor for DN and its role in early diagnosis of diabetic nephropathy.

Methods: This prospective cohort observational study was carried out on 60 subjects. All subjects were divided into 3 equal groups: Group I: Patient with type 2 DM. with UACR<30 mg\gm. Group II: Patient with type 2 DM. with UACR 30-300mg\gm. Group III: Healthy Controls (matched with other groups as regard the age, gender and body mass index). All patients were subjected to routine laboratory investigation and specific laboratory investigation (Urinary Vitamin D Binding Protein by ELISA).

Results: The area under the ROC curve of urine VDBP levels for the diagnosis of DN was 90%. The analysis rendered an optimum cut-off value of $$\geq$$125µg/ml/mg corresponding to 77.50% sensitivity and 85.00% specificity. There was significant positive correlation between Urinary VDBP level and FBS serum level (P value<0.001). There was significant positive correlation between Urinary VDBP level and HA1C serum level (P value<0.001)

Conclusions: Our findings indicate that UVDBP levels may be a potential biomarker for early detection of DN. In the present study, urine samples were collected from patients with DN only but not from patients with additional nephropathies. This may have caused an overestimation of the specificity of VDBP as a biomarker for the detection of DN.

##### Study of Cognitive and Behavioral Impacts of Idiopathic Epilepsy and Antiepileptic Drugs (AEDs) in Children and Adolescents

Mohamed Ibrahim Aboeisa, Mohammad Abdel Hakeem Seleem, Tarek Mohamed El Gohary, Azza Kamal Al Shahawy

Journal of Advances in Medicine and Medical Research, Page 176-187
DOI: 10.9734/jammr/2022/v34i1931451

Background: Epilepsy is a common neurological condition that can have a detrimental impact on social, emotional, and cognitive functioning. Psychiatric and cognitive problems in children with epilepsy and antiepileptic drugs can affect quality of life. Long-term follow-up studies reveal that epilepsy that develops in childhood is more common than epilepsy that develops later in life. Has a marked impact on adult life even when the epilepsy is not complicated by intellectual disability or other neurological impairments. The aim of this study was to study cognitive and behavioral impacts of idiopathic epilepsy and antiepileptic drugs in children and adolescents compared to normal ones.

Methods: This prospective, case control study was conducted on 60 children or adolescents suffering from idiopathic epilepsy aged 6-16 years. Children were classified into four equal groups and were examined after 6 months from diagnosis: Group A subjected to valproic acid at a dose of 10-60 mg/kg/day, group B subjected to Carbamazepine at a dose of 10-30 mg/kg/day, group C subjected to levetiracetam at a dose of 10-60 mg/kg/day and group D subjected to Oxcarbazepine at a dose of 20-30 mg/kg/day. Thirty healthy children or adolescents of matched age and sex served as a control group who attended Pediatric General Outpatient Clinic of Tanta University Hospitals. The following was done to all of the patients: full history taking, complete physical examination, routine laboratory investigations, electroencephalography, brain magnetic resonance imaging, specific tests for behavior and executive functions including the Child Behavior Checklist – school age, Stanford-Binet Intelligence Scales (fifth version), Wisconsin Card Sorting Test and Continuous Performance Test. Thirty healthy children or adolescents of matched age and sex served as a control group.

Results: Children with epilepsy who were treated with AEDs showed higher behavioral problems scales, lower mean IQ and lower executive functions as compared to controls. LEV and VPA had a more negative effect on behavior than CBZ and OXC while VPA and CBZ had a more negative effect on mean IQ and executive functions than LEV and OXC.

Conclusion: Antiepileptic drugs (AEDs) may be one of the causes of epilepsy-related cognitive and behavioral issues in children.

##### Demographic Factors, Comorbidities and Symptoms Prevalent among Patients with COVID-19 in a Tertiary Health Institution in Nigeria

Journal of Advances in Medicine and Medical Research, Page 188-196
DOI: 10.9734/jammr/2022/v34i1931452

Background: Studies have suggested that patients’ medical data could be correlated with the disease outcome in individuals with COVID-19. There is however, paucity of data on the impact of many of these factors especially in rural and semi-urban environment in Nigeria.

Objective: This study seeks to establish the dynamics of patients tested for COVID-19 in a private tertiary facility located in a semi-urban area in Nigeria, with special focus on their symptoms, comorbidities, and demography.

Methods: The study was a retrospective study carried out using data generated by the Babcock Molecular and Tissue Culture Laboratory of Babcock University Teaching Hospital Ilisan-Remo, Ogun state between October 17, 2020 and July 20, 2021. Statistical analysis was carried out using Statistical Package for the Social Sciences version 21.0.

Result: Two thousand five hundred anonymized data were captured in the study. Under the period of review, only 9.5% of the entire tested population were positive to the SARS-CoV-2 virus. There was a significant relationship between age distribution, level of education and COVID-19 infection outcome (P < 0.05). Fever (42.6%) was the commonest symptom among the patient population while hypertension (34.6%) and diabetes (31.3%) were the leading comorbidities reported in this study.

Conclusion: Targeted approaches in the areas of tests and enlightenment for certain demographic groups such as those that are elderly and with low level of education is highly recommended.

##### Outcome of Laparoscopic Management of Undisturbed Ectopic Pregnancy Versus Medical Management

Sara A. El Shora, Sherief L. EL-Shawikh, Adel E. El-gergawy, Mostafa Z. Mohamed

Journal of Advances in Medicine and Medical Research, Page 197-204
DOI: 10.9734/jammr/2022/v34i1931453

Background: Ectopic pregnancy (EP) is major health problem that women experience during reproductive years. The most frequent type of EP is tubal pregnancy, while non-tubal and heterotopic extra-uterine pregnancies are rare. Recently; ectopic pregnancy can be diagnosed before patient's clinical state is worsened.

Aim: was to compare outcome of laparoscopic therapy of undisturbed adenexial ectopic pregnancy versus medical therapy by methotrexate.

Methods: This randomized controlled clinical study on 50 patients attending outpatient clinic and inpatient at Department of Obstetrics and Gynecology -Tanta University Hospital. The study participants included women who underwent laparoscopy or underwent medical therapy with MTX for undisturbed adenexial ectopic pregnancy. We analyzed data of 50 women 25treated with single dose MTX and 25 cases treated with laparoscopy for undisturbed adenexial ectopic pregnancy between 2020and 2021. Success of treatment in laparoscopy group was deﬁned as significant decrease in one week post-therapeutic quantitative β- HCG, while in MTX group success of treatment was defined as decrease in BHCG level more than15% between day 4 and day 7, with no need for surgical intervention..

Results: Success of treatment in laparoscopy group (23cases, 92%) and (18 cases, 72%) in methotrexate group, no statistically significant difference between two groups (p=0.306). In methotrexate group the 7 cases who had failed medical therapy, underwent laparoscopy. There was no statistically significant difference between the two groups regarding persistent trophoblast (p=0.490), as two (8%) cases in laparoscopy group, while no cases in methotrexate group.

Conclusions: Laparoscopic surgery is as effective as methotrexate therapy for conservative therapy of undisturbed adenexial ectopic pregnancy and methotrexate has advantage of being non-invasive procedure.

##### Evaluation of Coronary Stent Expansion during Percutaneous Coronary Interventions Using Stent Boost Visualization in Comparison with Intravascular Ultrasound

Omran Mohamed Omran, Mohammed Hamed Sherif, Ekram Sadek Saied, Medhat Mohamed El-Ashmawy, Amr Dawood El-guindy, Samia Mahmoud Sharaf El-den

Journal of Advances in Medicine and Medical Research, Page 205-215
DOI: 10.9734/jammr/2022/v34i1931454

Background: Even in the era of drug-eluting stents, underexpansion of coronary stents remains a prominent cause of in-stent thrombosis and restenosis in patients having percutaneous coronary interventions (PCI). The aim of this work was to evaluate the value of using stent boost (SB) to detect stent under expansion (UE) by comparing this method to the gold-standard method of measurement by intravascular ultrasound (IVUS).

Methods: This prospective observational cross-sectional research enrolled 21 cases with chronic coronary artery disease who had elective PCI with IVUS and SB. Every patient was exposed to full history taking, full clinical examination and echocardiography. Pre-stenting IVUS was done to assess lesion characteristics, vessel measurements specifically distal reference lumen diameter and area (distal RLD, RLA) and to assess the size of the needed stent. SB image was obtained helped by the deflated balloon of the immediately deployed stent. IVUS was introduced post-stenting to obviate any hidden complication as well as to assess stent measurements of minimal stent diameter and area (MSD, MSA), hence, identify the group of patients with stent UE for which subsequent high pressure balloon dilatation was done. Post-procedure off-line processing of SB and QCA images to evaluate the presence of UE by both modalities.

Results: SB showed good agreement to IVUS regarding MSD which became optimal agreement when done for Xience Xpedition stent (as the commonly used stent in our study).  SB was able to detect optimal expansion compared to IVUS with 100% sensitivity and 33.33% specificity (p =0.005, AUC=0.808) at cut-off value criteria of MSD/distal RLD of 70%. The specificity increased to 66.67% when the cut-off value criteria of MSD/distal RLD was 76%. There was less agreement between QCA and IVUS.

Conclusions: Stent boost showed good agreement to IVUS regarding MSD which became optimal agreement when done for Xience Xpedition stent (as the commonly used stent in our study). SB was able to detect optimal expansion compared to IVUS with 100% sensitivity and Expedition 66.67% specificity (p =0.005, AUC=0.808) at MSD/distal RLD of 76% as a cut-off value criteria.

##### Role of Gamma Glutammyl Transpeptidase to Platelet Ratio (GPR) in Predicting Advanced Liver Fibrosis in Patients with Chronic Hepatitis C Infection

Raja Taha Yaseen Khan, Hina Ismail, Muhammad Danish, Muhammad Qaiser Panezai, Abdullah Nasir, Kiran Bajaj, Ghulamullah Lail, Rajesh Mandhwani, Husnain Ali Metlo, Danish Kumar, Munir Tareen, Abbas Ali Tasneem, Farina M. Hanif, Syed Mudassir Laeeq, Nasir Hasan Luck

Journal of Advances in Medicine and Medical Research, Page 216-223
DOI: 10.9734/jammr/2022/v34i1931455

The liver biopsy is the gold standard for the diagnosis of liver fibrosis, because of its invasiveness, high cost and lack of repeatability its use is limited. A new parameter widely used these days for evaluating the grade of hepatic fibrosis is the gamma-glutamyl transpeptidase (GGT)-to-Platelet ratio (GPR) and has shown great benefit in this regard. The aim of our study was to evaluate the role of GPR as a noninvasive predictor of liver fibrosis in patients with chronic hepatitis C in the study population.

Methods: All patients with chronic hepatitis C and compensated liver disease were included in the study after informed consent. Patient’s baseline characteristics were recorded. Patient’s baseline Complete blood count (CBC) and Liver function tests were also recorded. Patients then underwent shear wave elastography (SWE) to stratify the degree of fibrosis. These indices were used to calculate Gamma glutamyl transpeptidase (GGT) / platelet ratio. Results were presented as means ± SD for quantitative data or as numbers with percentages for qualitative data. Continuous variables were analyzed using the Student’s t-test; while categorical variables were analyzed using the Chi-square test. A p value of <0.05 was considered statistically significant.

Results: A total of 91 patients were included in the study. Out of 91 patients, 56(61.5%) were males. At baseline, 57(62.6%) patients had ≥F3 fibrosis (advanced fibrosis or cirrhosis). Mean GPR was 1.5±2.1. Area under ROC (Receiver Operating Curve) was obtained for GPR in predicting advanced liver fibrosis (≥F3) was 0.8 (p-≤0.001). Higher GPR values were significantly associated with prediction of advanced liver fibrosis (≥F3) in patients with chronic hepatitis C with a sensitivity was of 94.74%, specificity of 62%, positive predictive value of 80.69%, negative predictive value was of 87.50% and diagnostic accuracy of 82.42%.

Conclusion: The GPR found to be significantly associated with liver fibrosis in HCV patients presented in our clinic. However, further studies are needed to validate the role of GPR in predicting liver fibrosis.

##### Evaluation of Revised Trauma Score in Polytrauma

Mohamed M. Elshamhoot, Wesam Ibrahim, Mohamed F. Metwally, Mahmoud A. Elafifi

Journal of Advances in Medicine and Medical Research, Page 224-233
DOI: 10.9734/jammr/2022/v34i1931456

Objectives: This study aims to improve the management processes of polytrauma patients by evaluating the Revised Trauma Score (RTS) in predicting trauma outcomes by studying the incidence of mortality, intensive care unit (ICU) need and duration of hospital stay.

Methods: Our study had carried out fifty patients with polytrauma examined at Emergency and Traumatology Department, Tanta University Hospital in the period between beginning of December 2020 to beginning of December 2021. Including all polytraumatized patients with age ≥18 years and excluding patients who arrived dead or who had significant co-morbidity.

Results: The mean RTS value for survival was 7.05 (min-max=5.67-7.84), and was 4.73 (min-max=1.96-6.9) in non-survivals. Mean GCS for survival was 13.1 (min-max=8-15), and was 7.13 (min-max=3-13) in non-survivals.

The mortality prediction of the GCS, RR and SBP were also compared using univariate logistic regression. The OR of the actual GCS score was 0.492 (p <0.001; 95% CI, 0.338 – 0.714). While was 0.940 (p =0.005; 95% CI, 0.910-0.983) for SBP and 0.892 (p =0.023; 95% CI, 0.809 – 0.985) for RR.

When the performances of the RTS in predicting in-hospital mortality was evaluated through ROC analysis, the AUC was 0.919 (95% CI 0.806 to 0.977) (p<0.001).

Conclusion: RTS is a good predictor of prognosis among trauma patients.  The lower the RTS is significantly associated with a higher mortality and long hospital stay. Early evaluation of the injury level can be effective in patients' management. The revised trauma score is a reliable indicator of prognosis of polytraumatized patients. Therefore, it can be used for field and emergency room triage.

##### Effect of Social Determinants on Knowledge and Barriers to the use of Preventive Measures against SARS-CoV-2 Infection

Nicolas Padilla-Raygoza, Gilberto Flores-Vargas, María de Jesús Gallardo-Luna, Efraín Navarro-Olivos, Jorge Patricio Meza-Rodríguez

Journal of Advances in Medicine and Medical Research, Page 234-244
DOI: 10.9734/jammr/2022/v34i1931457

Aims: To analyze the effect of social determinants on knowledge and barriers to using protective measures against SARS-CoV-2 infection.

Study Design:  Analytical cross-sectional study.

Place and Duration of Study: Sample: Institute of Public Health Staff from Guanajuato State and their relatives, between June 2009 and July 2010.

Methodology: As social determinants, data on age, sex, marital status, and academic degree were obtained. Knowledge and barriers were quantified by a purposely designed questionnaire, with construct validity and reliability of 0.70 (95% CI 0.61 - 0.78) (Cohen's Kappa). The survey was sent by e-mail to the Institute workers. They were allowed to invite their relatives aged 18 or over.

Results: 1,414 questionnaires were obtained with a participation rate of 9.49%. The age ranged from 18 to 75 years, with a mean of 39.51 ± 10.02 years. Women predominated with 69.59%, persons with married status with 51.49%, and academic degrees with 55.80%. All participants showed adequate knowledge. There were internal and external barriers. The only one that showed a relationship and effect with social determinants was that the protective measures were expensive (with gender, X2= 10.35 df 1 P=.001), OR=0.65 (95% CI 0.50 – 0.85); for the rest of the social determinants (age, marital status, and academic degree) they did not show any relationship or effect.

Conclusion: All participants had adequate knowledge and a few barriers to using the preventive measures against SARS-CoV-2.

##### Management of Complex Wide Neck Intracranial Aneurysm

Journal of Advances in Medicine and Medical Research, Page 249-259
DOI: 10.9734/jammr/2022/v34i1931459

Background: About 5 % of the population has intracranial aneurysms, however the majority are asymptomatic and never discovered. Subarachnoid haemorrhage, the most frequent manifestation of aneurysm rupture, is a devastating medical disorder that frequently results in severe neurological impairment or death. The aim of this work was to evaluate the efficacy and safety of our procedures including microsurgical and endovascular techniques used for the management of complex wide neck intracranial aneurysms.

Methods: This prospective study was carried out on 50 patients with complex wide neck intra cranial aneurysms. All patients were subjected to neuroimaging (CT Brain, MRI brain, MRV, CT brain angiography and diagnostic angiography) and laboratory investigations (CBC, liver and kidney functions and complete coagulation profile).

Results: Remodelling technique was the most common technique used for ruptured aneurysms (14 %) followed by clipping (6%). Regarding 3months follow up, the group who had ruptured aneurysm had lower incidence of occlusion and higher incidence of recanalization. The relationship between technique used and outcome (mRS grade) was significant being better with Coilin + balloon technique followed by flow diversion then Coiling+ stent.

Conclusions: Endovascular techniques are better to deal with the complex anatomy of intracranial aneurysms. In case of ruptured aneurysm, the earlier the treatment, the better the outcome by preventing the hazards of rebleeding and safe management of vasospasm. CT Brain Angiography with 3D reconstruction proved to be a fast and reliable method for diagnosis and preoperative planning for cerebral aneurysms.

##### Role of Surface APRIL (A Proliferation Inducing Ligand, CD256) Expression in Patients with Rheumatoid Arthritis

Hanaa Mohammed Abd Raboh, Hanan Mohammed El Saadany, Maaly Mohamed Mabrouk, Hanaa El-Sayed Nofal

Journal of Advances in Medicine and Medical Research, Page 260-268
DOI: 10.9734/jammr/2022/v34i1931460

Background: A Proliferation Inducing Ligand (APRIL) is a member of the tumour necrosis factor (TNF) superfamily and is released by activated T and B cells, monocytes, dendritic cells, macrophages, neutrophils, myelocytes, astrocytes, and adipocytes. The aim of the study was to evaluate the APRIL; CD256 surface expression on circulating monocytes in rheumatoid arthritis (RA) patients and disease activity.

Methods: This case control study was conducted on 60 subjects They were classified into two groups: group 1: 20 apparently healthy subjects as a reference group., group 2: 40 patients with RA according to DAS28, they were subdivided into two equal subgroups: active rheumatoid arthritis. and inactive rheumatoid arthritis

Results: There was a statistical increase in surface APRIL expression in active group and inactive group when compared to normal controls and there was also statistical increase in surface APRIL expression level in active group when compared to inactive group. There was no significant correlation between surface APRIL expression with RF (p=0.745) Anti CCP (p=0.375), Hb (p= 0.056), PLT (p= 0.980), WBCs (p= 0.252), AMC (p= 0.890).

Conclusions: Surface APRIL expression is increased on circulating monocyte subsets in RA patients where it is highly correlated with the activity of the disease. Monocytes in patients with RA is shifted toward intermediate and non-classical monocytes, populations of monocytes known to produce the inflammatory cytokines TNF-α important in the pathogenesis of RA.

##### Greek Public Knowledge and Attitudes in Response to the COVID-19 Pandemic

Dimitrios Theofanidis, Antigoni Fountouki

Journal of Advances in Medicine and Medical Research, Page 269-278
DOI: 10.9734/jammr/2022/v34i1931461

Introduction: Corona viruses are a group of viruses that often cause generally mild respiratory infections in humans and animals. Most people are infected with Corona Viruses at least once in their lives, having mild to moderate symptoms of common cold.

Aim: The purpose of this study was to examine and investigate attitudes, perceptions and public knowledge to deal with the COVID-19 pandemic. In particular, it was to investigate people's perceptions of the new COVID-19, to assess citizens' knowledge of symptoms transmission and prevention against the new COVID-19 disease and to investigate public attitudes during social containment.

Study Design: Quantitative survey design.

Place and Duration of Study: Sample: 341 Greek citizens were randomly selected and included in the study between June 2020 and August 2020.

Methodology: Due to the COVID-19 outbreak, our research was conducted through Google Drive online form sent via Facebook and Messenger to each individually by personal message and by e-mail, to which the questionnaire was sent as an attached file.Such research is aimed at the population who understand social media and with access to the internet.

Results: With regard to the participants overall assessment of their knowledge on COVID-19, 8% self-evaluated themselves as having ‘poor’ knowledge, 42% as having ‘moderate’ and 50% as having ‘very good to excellent’ knowledge on the subject. Majority stated that they acquired information on COVID-19 mainly from the Internet and/or mass media (86%) followed by Medical/Nursing staff with 71%, and family/friends 65%. Almost half of the sample, (i.e. 49%) stated that they, or a member of their family, were considered to be a vulnerable group. Also, from ANOVA variance analysis, it appears that differences between educational level groups are statistically significant regarding the need for psychological support in the period of isolation; F(4,136) = 3,602, p< 0.05). With regard to being afraid of contracting the virus either themselves or any member of their family, as shown by Table 4, respondents belonging either themselves or one of their family members to a vulnerable group show higher levels of fear of being affected by COVID-19 (M = 4.18, T.A. = 1.01) against stocks.

Discussion: The results of the study showed that public knowledge on COVID-19 shows a positive correlation with the implementation of the measures, meaning that those who know more about nature of COVID-19 are more stringent with prevention measures. Adherence to these, in turn, displays a positive correlation with the need for psychological support during the period of confinement. Therefore, the higher the levels of adherence to the measures, the greater the need for psychological support during the period of confinement.

Conclusion: The overall impression of this study suggests that simple straightforward preventive health measures provided to the public tended to be followed. Yet, the greatest problem lies in misinformation on the pandemic which seems to confuse, especially those with lower educational backgrounds.

##### The Expression of E-cadherin & HER2 in Gastric Carcinoma

Dina Said El-Mihy, Eiman Adel Hasby, Azima Gamal El-Deen Noseir, Basma Saed Amer

Journal of Advances in Medicine and Medical Research, Page 279-294
DOI: 10.9734/jammr/2022/v34i1931462

Background and Aim: Cell adhesion molecules (often referred to as cadherins) are glycoproteins found in the cell membrane. They regulate biological processes such as cell migration, differentiation, proliferation, and death (apoptosis). Her-2 is a proto-oncogene that belongs to the EGFR protein family. In cellular processes such as cell growth, regulates cellular activities such as proliferation, differentiation, and survival. This study aimed to determine the expression of E-cadherin and HER2 in the available histologic subtypes and evaluate if there is a correlation between E-cadherin and HER2 immunohistochemical expression in gastric carcinoma.

Subjects & Methods: A total of 50 cases of stomach cancer were included in this study, all of which were obtained retrospectively between January 2017 and January 2020 from the Pathology Department, Tanta University, Egypt and Tanta Cancer Center archives. The samples were obtained from gastroplastectomy specimens then stained using the immunostaining approach described as follows: Deparaffinization and rehydration followed by using 3-hydroxy-4-napthylbenzaldehyde (3-OH-4-NHB) as a starting material then a smorgasbord of antigens then exposing to primary antibodies then exposing to a secondary biotinylated antibody, after that identifying of enzymes using streptavidin-labeled enzymes then preparing a color working reagent and last complexity in the development of color.

Results: E-cadherin was statistically significantly high in tumors exhibiting aggressive clinicopathologic characteristics specifically in males, all histopathologic variants (except for poorly differentiated tubular adenocarcinoma and signet ring carcinoma), N stages, M stages, higher in absent vascular invasion cases but lower in present cases and the same with perineural invasion cases. Tumor site had no significant impact on the levels of E-cadherin. HER2 showed statistically insignificant correlations with all factors. E-cadherin and HER2 expression showed statistically insignificant relationship.

Conclusion: Elevated E-cadherin expression is associated with tumors that exhibit aggressive clinicopathologic characteristics. HER2 was expressed positively in low-grade variants, but no correlation was established with clinical characteristics. E-cadherin and HER2 expression have no discernible relationship.