Open Access Case Report

Negative-pressure Pulmonary Edema Following Sustained Laryngospasm during Emergence from Anesthesia in a Young Adult Undergoing Facial Surgery: A Case Report

Jihyun Song, Byung Gun Lim, Seok Kyeong Oh, Jae Hak Lee

Journal of Advances in Medicine and Medical Research, Page 123-128
DOI: 10.9734/jammr/2022/v34i2031477

Post-extubation negative-pressure pulmonary edema (NPPE) develops after the closed intrathoracic cavity was forced to expand with intense inspiratory effort against an obstructed airway. Laryngospasm that occurs after extubation during emergence is one of the causes of upper airway obstruction. Extubation during an inadequate depth of anesthesia, excessive airway secretion and irritation due to suction are known as cause of laryngospasm. Recently, there have been reports that laryngospasm occurred after sugammadex administration during emergence from general anesthesia. Here, we report NPPE following consecutive sugammadex administration during emergence from anesthesia in a young man undergoing nasal septorhinoplasty under general anesthesia. In this case, NPPE occurred due to an excessive increase in inspiratory force in the state of airway obstruction (laryngospasm) after extubation, and a young man, nasal surgery with packing, and repeated misuse of sugammadex due to absence of neuromuscular monitoring could contribute to the occurrence of NPPE.

Open Access Case Report

Reversible Heavy Premature Ventricular Contraction Burden without Electrophysiology Intervention: Two Case Reports

Nada AlSultan, Sarah AlSulaiman, Malak AlNaim, Muneera AlTaweel, Sarah AlMukhaylid

Journal of Advances in Medicine and Medical Research, Page 302-308
DOI: 10.9734/jammr/2022/v34i2031498

PVCs, or premature ventricular complexes, are prevalent diagnoses in the general population and frequently show up incidentally in people. The sense of "skipped beats" might be brought on by PVCs emanating from ectopic ventricular nuclei. People with underlying cardiovascular illness,  and electrolyte abnormalities such as hypomagnesemia, hypokalemia, and Vitamin D deficiency, as well as elderly adults, were shown to have a greater prevalence of PVC. We represent two instances of PVCs, one in a 33-year-old male and one in a 50-year-old woman, both of whom attended with sensations of palpitations, risk factors were determined, medically appropriately controlled, and the PVCs burden was diminished without intervention. Mitigating the use of antiarrhythmic medications and averting unnecessary electrophysiology procedures can be accomplished.

Open Access Systematic Review Article

Alzheimer's Disease and the Possible Role of Vitamin D

Sheren Ahmed Azhari

Journal of Advances in Medicine and Medical Research, Page 19-30
DOI: 10.9734/jammr/2022/v34i2031465

Alzheimer's disease (AD) is a neurological illness that causes dementia. Despite the enormous global economic cost and impact on patients' immediate family members, there is no definitive cure, necessitating the development of improved therapeutic options. While memory and cognition are significantly impaired with (AD), the actual cause remains unknown. Among well-known hypotheses used to explain AD pathophysiology is Amyloid (A β) plaque development and aggregation hypothesis. There are now five FDA-approved medications that are used as therapy alternatives. All medications are used to treat symptoms of (AD.) So, disease modifying treatments that target the AD pathological changes, are required. Those treatments may targeting suppression of the pathogenesis pathways. Vitamin D is generated in human epithelial cells through the photochemical formation and is also obtained through dietary resources. Calcium homeostasis and bone metabolism are two of the most well-known vitamin D impacts. Aside from that, non-traditional vitamin D benefits have recently acquired popularity. Vitamin D regulates the growth and activities of the central nervous system, which is an important but less understood function of the vitamin. Vitamin D's neuroprotective properties are associated with its effects on neurotrophin creation and secretion, neuromodulator synthesis, intracellular calcium homeostasis, and avoidance of oxidative nerve damage. The protective and therapeutic effects of vitamin D on neurodegenerative diseases are not intensively investigated

In this review, a comprehensive approach to understanding the pathogenesis of AD and the possible role of vitamin D in the protection and therapeutic of AD were addressed.

Open Access Systematic Review Article

The Potential Role of Colchicine in Reducing Mortality and Mechanical Ventilation Rates in COVID-19 Infection: A Meta-analysis

Shilpa Rai, Shahbaz Singh Nijjar, Blessing T. OJinna, Iqra Mukhtar, Maryam Ahmed, Opeyemi Tobalesi, Prerna Singh, Olamide Adefashola, Abiodun O. Aboaba, Danish Waqar, Jeffrey Ndove, Frederick Ferguson, Adewale Mark Adedoyin, Patrick Batti, Hammad Zafar

Journal of Advances in Medicine and Medical Research, Page 349-358
DOI: 10.9734/jammr/2022/v34i2031503

Background: Colchicine is one of many drugs being repurposed for COVID-19 due to its potential as an anti-inflammatory agent alongside its easy accessibility and oral administration. This study aims to identify the risk reduction in mortality and mechanical ventilation of colchicine-treated COVID-19 patients compared to the standard of care/placebo.

Methods: A systematic search was conducted until December 31, 2021, with keywords including Colchicine, COVID-19, SARS-CoV-2, anti-inflammatory, trials, clinical, mechanical ventilation, death, and mortality. Databases including MEDLINE/PubMed, Scopus, Web of Science, CINAHL Plus, Cochrane, WHO Global Database, and Preprint servers were searched. Using dichotomous data for all values, the risk ratios (RR) were calculated by applying the random-effects model in Review Manager 5.4.

Results: The 12 studies pooled 17,297 participants, with 8,528 patients in the colchicine group and 8,769 in the standard care group. Colchicine treatment led to a statistically significant reduction in the risk of death (RR=0.63, 95% CI=0.48-0.84, P=0.001). Moderately high heterogeneity was present among the included studies (I2=72%). While insignificant, the risk of mechanical ventilation was decreased by 12% among the colchicine group (RR=0.88, 95% CI=0.64-1.22, P=0.44).

Conclusions: While this meta-analysis finds overall reductions in mortality with colchicine treatment, these findings must be utilized with caution. Placebo-controlled randomized clinical trials are warranted at a large scale to validate the viability of colchicine as an adjuvant treatment for COVID-19. On obtaining more concrete findings, the potential role of colchicine may be better optimized in non-severe patients as well, across in-hospital and outpatient settings.

Open Access Case Study

New Paradigm in Explaining Dry Socket: Case Studies

Wael Khalil

Journal of Advances in Medicine and Medical Research, Page 276-281
DOI: 10.9734/jammr/2022/v34i2031495

Dry socket is considered as the most common complication following tooth extraction. It is mainly manifested by severe irradiating pain that starts 2 to 4 days after dental extraction with a denuded socket. Although many risk factors are associated with it, no clear and direct cause has been described to explain its etiopathogenesis. Here, we suggest a new pathogenesis and a new management of  dry Socket based on new microbiological findings from 3 clinical cases.

We present a series of 3 Dry Socket cases from which alveolar swabs have been taken for microbial exploration. Materials from the 3 cases were subjected to bacterial culture and susceptibility testing.

Microbiological results showed the presence of Pseudomonas aeroginosa in all samples. Furthermore, the antibiogram showed sensitivity to Ciprofloxacin. These results suggest a new approach in preventing and treating Dry Socket based on an infectious process.

Open Access Case Study

An Unusual Appearance of Cystic Gastro Intestinal Stromal Tumor of Small Intestine - A Case Report and Brief Review of Literature

P. P. Bhadani, A. Singh, G. K. Gupta, K. Parasar

Journal of Advances in Medicine and Medical Research, Page 282-288
DOI: 10.9734/jammr/2022/v34i2031496

Gastrointestinal stromal tumor (GIST), is considered as most common mesenchymal neoplasm of the GI tract. They can arise anywhere in the gastrointestinal (GI) tract, with the gastric GIST accounting for 50% to 60% of cases, the small intestinal GIST for 20% to 30%. It arises from the interstitial cells of Cajal, which are part of the muscle plexes of the intestine.Radiologically, they are best identified by Computed Tomography (CT) scan. Grossly, GIST is a solid tumorbut infrequently shows cystic degeneration. Immunohistochemistry( IHC) shows positivity for CD117 (C-Kit), CD34, and/or DOG-1. Radical resection is currently the preferred treatment for small intestinal GISTs.During the past decade, GISTs have presented as an important model in the emerging field of molecularly targeted therapies for solid tumors. Here we report a case mutifocal GIST with unusual gross appearance of cystic degeneration.

Open Access Study Protocol

Effect of Encapsulated Human Islet Cells Implantation on Insulin Dependency in Diabetes Mellitus: An Innovative Approach

Hina Usmani, Ravi Kant, Anissa Atif Mirza, Ravi Prakash Meshram

Journal of Advances in Medicine and Medical Research, Page 53-60
DOI: 10.9734/jammr/2022/v34i2031468

Background: Globally, the number of diabetic patients has quadrupled in last 30 years and diabetes mellitus (DM) is among the major causes of death with rank 9 worldwide. Approximately there is 1 patient with DM in 11 people worldwide. Asia is among the major areas of where T2DM is rapidly emerging into global epidemic. In Asian countries China and India are top two epicenters for this rapidly emerging epidemic. Studies have shown that without immunosuppression in diabetic animal model, normoglycemia is maintained after implantation of encapsulation technique (macro/micro-encapsulation) containing islets at different sites in body. If this study could work well, it will be possible to implant a capsule in diabetic patient reducing dependency on insulin from outside using other methods like multi-layer-by-layer encapsulation. Purpose of this study will be to determine whether encapsulation of pancreatic β-cell in subcutaneous region could protect human islets from rejection and autoimmune destruction in diabetic patients, by overall decreasing insulin dependency in T2DM patients without immunosuppression.

Methods and analysis: Protocol will be based on multi-layer-by-layer encapsulation procedure.

Discussion: To our knowledge, there are no such studies which are performed in phases making this study to be a best example of evidence based protocol. Appropriate subgroup analysis has been planned while performing animal experimentation. Routine postoperative monitoring have been planned to ensure Ethics and dissemination. Analysis of encapsulation in different conditions i.e. in-vitro and in-vivo will provide diverse data on effects of encapsulated islet cells on different environmental conditions. In-vitro data will be compared with in-vivo data in order to find out detailed successful results. According to this protocol, if we will be able to develop encapsulated human islet cells that will produce insulin and decrease insulin dependency then this study will be a novel interventional research to decrease burden of insulin therapy in low income population such as of India.

Open Access Original Research Article

MRI Supplemented with Diffusion Weighted Image in Characterization of Soft Tissue Masses of the Wrist and Hand

Asmaa Yehya Abdallah Elsharkawy, Hanan Mohammed Omara Elsadany, Rasha Lotfy Younes, Omar Ahmed Hassanien

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/jammr/2022/v34i2031463

Background: The wrist joint is considered to be a condyloid synovial joint of the distal upper limb that connects and serves as a transition point between the forearm and hand. Hand and wrist soft tissue masses comprise a special subset of soft tissue masses. MRI imaging has an important role in characterization of soft tissue tumors, yet, it lacks specificity for differentiation between benign and malignant lesions.Diffusion-weighted imaging (DWI) is a non-invasive method for investigation of tumor histological content and used for differentiation between benign and malignant masses.

Aims: This study aimed at assessment of the role of MR diffusion Weighted imaging (DWI) in the evaluation of soft tissue masses of the wrist and hand.

Patients and Methods: This study conducted on 30 patients with soft tissue masses of the wrist and hand. They were referred from Orthopedic and Physiotherapy Departments to MRI unit in Radio-diagnosis Department, Tanta University Hospital. The study was conducted from November 2018 to November 2019. MRI with DWI was conducted for each one of them and results were correlated with histopathological examination.

Results: There is a significant difference in the mean ADC value between benign and malignant soft tissue tumors. Increased apparent diffusion coefficient (ADC) values represent an increase in extracellular water or loss of cell membrane integrity whereas decreased ADC values reflect decrease in extracellular water content or increase in cell number or size.

Conclusions: this study proved the role of MRI and supplementary Diffusion weighted image (DWI) with numerical ADC values in characterization of soft tissue masses of the wrist and hand.

Open Access Original Research Article

Role of Three‐dimensional Power Doppler Ultrasonography in Diagnosis of Placenta Accreta Versus Two‐dimensional and Color Doppler Ultrasonography

Nabila A. Elshorbagy, Aml A. Elsokary, Mohamed M. Hefeda, Ahmed T. Soliman

Journal of Advances in Medicine and Medical Research, Page 7-18
DOI: 10.9734/jammr/2022/v34i2031464

Background: Placenta accreta is a condition of abnormal placental implantation in which the placental tissue invades beyond the decidua basalis. It may invade into or even through the myometrium and adjacent organs, such as the urinary bladder. It is a major cause of obstetric hemorrhage and complication leading to significant maternal morbidity and mortality. The aim of this study is to compare the role of three-dimensional power Doppler ultrasonography in the antenatal diagnosis of placenta accreta versus two-dimensional and color Doppler ultrasonography.

Methods: A prospective comparative study design was conducted.

This study was performed on 50 Pregnant females at the Department of Obstetrics and Gynecology, Tanta University Hospitals

Inclusion Criteria: Patients with placenta previa and previous one or more ceserian section at gestational age from 28 weeks to 36 weeks.

The diagnosis of placenta previa confirmed using all diagnostic techniques (gray scale, color Doppler, and 3D power Doppler) and full availability of delivery information.

Results: abnormal placental lacunae was most frequently encountered in 2D gray scale ultrasound as it was noted in 12 (24.0%) patients, thinning or disruption of hyperechoic serosa-bladder interface was detected in 8 (16.0 %) patients, loss of retroplacental sonolucent zone was detected in 7 (14.0 %) patients, irregular retroplacental sonolucent zone was noted in 5 (10.0%) patients, while presence of focal exophytic masses invading the urinary bladder was the least encountered as it was noted in 4 (8.0 %) patients.

The 2D gray scale initially diagnose 52.0% of study participants as placenta accreta and 48.0% as had no placenta accreta.

  Conclusions: There is no one imaging modality that provides the gold standard for diagnosing placental invasion. A high index of clinical suspicion is required for its detection in high risk patients. In contemporary obstetrical practice, this applies to patients with previous caesarean sections, and especially if there is a coexisting anterior low-lying placenta. A probable case of morbidly adherent placenta will benefit from preoperative multidisciplinary input and perioperative measures in preparation for an elective planned delivery

Open Access Original Research Article

A Proposal for a Novel Scoring System for Triage of Acutely Poisoned Patients at Tanta University Poisoning Treating Center, Egypt

Asmaa G. S. Abd Elfatah, Mona M. Ghonem, Amira A. Wahdan, Mona S. A. El –Gohary

Journal of Advances in Medicine and Medical Research, Page 31-45
DOI: 10.9734/jammr/2022/v34i2031466

Background: Poisoning is defined as exposure of an individual to a potentiality harmful substance either by inhalation, skin contact, ingestion, or injection.

Aim of the Work: This study aimed to develop and validate a novel scoring system using vital signs, arterial blood gases (ABG) and consciousness level as a tool of triage for evaluation and outcome prediction of acutely poisoned patients.

Methods: The current prospective cohort study was conducted on patients with acute poisoning who were admitted at Tanta University Poisoning Treating Center (TUPTC) throughout a period of start of April 2020 to the end of June 2021. For each patient, age, sex, and toxicological characteristics were obtained. Clinical examination and routine laboratory investigations were also done.

Results: Significant differences were observed between survivors and non-survivors in the derivation group (444 patients) regarding systolic blood pressure, diastolic blood pressure, respiratory rate, temperature, blood pH, PaCO2, serum HCO3, and O2 saturation. Using univariate and multivariate regression analysis SBP, serum HCO3, and O2 saturation were valid to construct the prediction score at cut off ≤100 mmHg, ≤16.6 mEq/L, and ≤93% respectively. Variables were given points and the score has range from 0 (the best score) to 3 (the worst score). The discrimination power in the derivation group at cut-off point >1 was excellent (AUC: 0.925) with 91.3% sensitivity and 94.9% specificity. Additionally, the discrimination power in the validation group (140 patients) at cut-off point >1 was excellent (AUC: 0.965) with 87.5% sensitivity and 93.8% specificity.

Conclusion: This proposed score could be considered a simple and excellent tool for triage to identify acutely poisoned patients who are at risk of mortality. In addition, it is validated and so it could be used in other populations.

Open Access Original Research Article

The effect of General Anesthesia Versus Spinal Anesthesia in Restoration of Gastrointestinal Motility after Cesarean Section

Naglaa Fathy Wally, Ahmed Mahmoud El Khayat, Ahmed Saeid Elgebaly, Lamiaa Mohamed El Ahwal

Journal of Advances in Medicine and Medical Research, Page 46-52
DOI: 10.9734/jammr/2022/v34i2031467

Background: Cesarean section is the delivery of a foetus through an open abdominal incision (laparotomy) and a uterine incision (hysterotomy). One of the most common postoperative complications is a dynamic paralysis (ileus) that must be minimized due to its serious consequences including delayed enteral feeding resulting in patient discomfort, prolonged hospitalization and increased health care costs. The pathophysiology of postoperative ileus is multifactorial. The aim of this study is to compare the effect of general versus spinal anesthesia in regain of the intestinal motility after elective cesarean section.

Methods: This randomized clinical study was conducted on 150 pregnant women aged from18 to 35 years, who were set for elective caesarean section under either general or spinal anesthesia, attending to the Obstetrics and Gynecology department from August 2020 to October 2021. The participants were subdivided into 2 equal groups, group I included women delivered by using general anesthesia and group II included women delivered by using spinal anesthesia.

Results: Shows 1st intestinal, 1st passage flatus, 1st passage motion and hospital stay were significantly increased among general group than the spinal group (P = 0.001*).

Conclusions: Spinal anesthesia results in a quicker return of bowel activity after cesarean section than general anesthesia with difference and spinal anesthesia results in a quicker return to home as it decreases the length of hospital stay with significant difference between both groups.

Open Access Original Research Article

Diagnostic Study of Serum Dickkopf 1 Level and Alpha Fetoprotein L3 as Tumor Biomarkers in Hepatocellular Carcinoma

Amira Mohamed El Sharkawy, Mohammed Hosny Fouda, Dina Hazem Ziada, Gihan Farouk Attia

Journal of Advances in Medicine and Medical Research, Page 70-77
DOI: 10.9734/jammr/2022/v34i2031469

Background: Alpha Fetoprotein (AFP) is now the most frequently applied tumour biomarker for the early diagnosis and clinical follow-up of HCC patients. Dickkopf 1 (DKK 1) is a protein that has a role in embryonic head morphogenesis. Several investigations revealed that DKK 1 regulates a variety of pathological and physiological processes. The aim of this work was to evaluate the diagnostic role of serum DKK 1 level and AFP- L3 as tumor markers in hepatocellular carcinoma.

Methods: This observational research enrolled 60 participants aged above 18 years, group 1 include 10 healthy control participants, group 2 involved 25 cirrhotic cases and group 3 involved 25 cases diagnosed with HCC. All cases underwent taking of full history, clinical assessment, radiology, laboratory examination and specific investigations such as the tested two markers AFP-L3 and DKK1.

Results: AFP-L3 had 84% sensitivity and 67.7% specificity, while DKK1 had sensitivity and specificity of 76% and 80% respectively to differentiate between cirrhotic and HCC cases, using a cut-off value of 8.62 ng/ml. two markers combination had specificity and sensitivity of 92%, 72% respectively and increase the accuracy for detection of HCC up to 82%.

Conclusions: Both AFP-L3 and DKK1 could act as surrogate biomarkers for HCC and combination of two markers should be kept in mind to reach the optimum accuracy.

Open Access Original Research Article

Telemedicine-the Most Convenient Method to Deal with Mental Health during the Pandemic-apollo Telehealth’s Qualitative Descriptive Study

Mubasheer Ali, Tabassum Sheikh, Ayesha Nazneen, Vikram Thaploo

Journal of Advances in Medicine and Medical Research, Page 61-69
DOI: 10.9734/jammr/2022/v34i2031470

Aims: This descriptive study aims to understand the positive impact created by tele counselling services on patients’ mental health during the COVID pandemic.

Study Design: Qualitative Descriptive study.

Place and Duration of Study: Medical Response Center, Apollo Telehealth.

Methodology: The sample consisted of 496 patients (194 Female, 301 male) who called the helpline number to seek psychological counselling over the period of 1 year 7 months (January 2020 to July 2021). The inclusion criteria included clients who had completed the counselling session successfully, Clients between 10 years and above, and Clients who availed the psychological counselling sessions.Clients below 9 years of age and Clients who are not enrolled as corporate beneficiaries of Apollo Telehealth were excluded from the research study.

Results: The majority of utilization was observed in the 18 states captured are Maharashtra (32%) followed by Karnataka (14%), Punjab (9%), Telangana (8%), Delhi (5%). It was also observed that 4% of our clients were slightly cautious about disclosing the state they were calling from however completed the session with us. The majority of clients (61%) were men aged between 30-39 years, married (65%).

86% seeked help for their self-issues and 14% called for support and guidance for their family and friends. Clients approached primarily for (37%) emotional issues followed by Interpersonal issues (22%).

Conclusion: The study findings support the continued use of telehealth services offered by mental health providers and organizations, as respondents indicated a desire to use these services as it was found to be more useful and helpful in dealing with their mental health issues and conditions during the pandemic. In summary, the results demonstrate a large shift in telehealth use and provide an encouraging outlook for the use of tele counselling and tele mental health services after the COVID-19 pandemic.

Open Access Original Research Article

Evaluation of the Intraocular Pressure Measurement in Patients with Primary Open Angle Glaucoma Using Corvis-ST

Maha El Sayed Mabrouk, Mohammed Hosny Nasef, Waleed Abd Elhady Allam, Ahmed Mohamed Ghoneim

Journal of Advances in Medicine and Medical Research, Page 78-85
DOI: 10.9734/jammr/2022/v34i2031471

Background: The Corneal Visualization Scheimpflug Technology device (Corvis ST tonometry: CST) is a novel noncontact tonometer developed to assess intraocular pressure (IOP) while accounting for the cornea's biomechanical qualities. The aim of this work was to assess reliability and accuracy of corvis-ST tonometer in measurement of IOP in cases of primary open angle glaucoma (POAG).

Methods: This prospective comparative non-interventional study included 70 eyes of patients suffering from bilateral POAG and with clear and virgin corneas. Eyes were divided into two groups: group A (40 eyes of POAG) and group B (30 normal eyes). All patients were subjected to: history taking, examination [visual acuity (VA), slit lamp examination, gonioscopy for angle, posterior segment, optic disc evaluation and IOP measurements] and investigations (Pachymetry and Corvis ST).

Results: There was a significant negative correlation between non-corrected IOP measured by Corvis and corneal biomechanical index in studied glaucoma patients. There is a positive significant correlation between first and second IOP readings by Corvis. This means that the first and second readings of IOP by corvis with interval 30 minutes between the two readings increased together and decreased together (positive relationship).

Conclusions: The IOP measurement in patients with POAG using Corvis-ST has a good reliability.

Open Access Original Research Article

Lack of Association between Cholelithiasis and Significant Coronary Artery Disease: An Autopsy Study from Greece

Christos Soutis, Chara Spiliopoulou, Nikolaos Goutas, Alexandra Ampati, Eleni Zorba, Anastasia Antoniou, Efstathios Skliros, Stavroula Papadodima

Journal of Advances in Medicine and Medical Research, Page 86-94
DOI: 10.9734/jammr/2022/v34i2031472

Aims: Cholelithiasis or Gallstone disease and coronary artery disease have been reported to share several common risk factors. The aim of this study was to examine if there is an association between coronary artery disease (CAD) and gallstone disease (GsD) through an autopsy study.

Methodology: A retrospective analysis of the records of consecutive autopsy cases performed at the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens during the period from January 1, 2011, to December 31, 2015, was performed. The inclusion criteria were age between 35 and 65 years old. Our sample consisted of 1699 cases. Significant CAD was defined as stenosis of the lumen equal to or over 75% in any major coronary artery.

Results: Significant CAD was found in 656 (38.6%) cases. Results showed that age, male sex, hypertension, smoking (P <0.001), presence of diabetes mellitus (DM)(P =0.005), hyperlipidemia (P =0.001), and illicit drug use (P =0.006) were statistically significant predictors of significant CAD presence. On the contrary, heavy alcohol use (P =0.069), GsD (P =0.838) and cholecystectomy (P =0.423) was not found to be related to significant CAD.

Conclusion: Our study did not show any statistically significant relationship between the presence of significant coronary artery stenosis and GsD. The same outcome was noticed when cholecystectomy was studied separately. Therefore, cholelithiasis and cholecystectomy cannot serve as possible predictors for CAD development. Future studies are needed to validate our findings that will lead to more beneficial prevention planning and monitoring of patients so as to maximize resources management and reduce healthcare costs.

Open Access Original Research Article

Effect of a Slow-firing Method on Porcine Small Intestine: Evaluation of Staple Malformation by Two Different Methods

Masahiro Kimura, Kotaro Mizuno, Koshiro Harata, Ken Tsuboi, Yuzo Maeda, Seiichi Nakaya, Hiroshi Uematsu, Syuhei Uehara, Tomohiro Kako, Takeshi Saito

Journal of Advances in Medicine and Medical Research, Page 95-100
DOI: 10.9734/jammr/2022/v34i2031473

Background: In addition to improvement in staplers, surgeons have made some ingenious changes in stapling techniques. There are few reports that have examined in detail the effect of one ingenious change, the slow-firing method, on the malformation of staples. In this study, the malformation of staples was examined from the viewpoint of twisting and wrapping of staple legs.

Methods: Fresh porcine small bowel was used for all experiments. The front and rear walls of the small intestine segments were stapled in the longitudinal direction. A powered Echelon Plus stapler with a GST cartridge and an EndGIA tri-stapler with an AMT cartridge were used. After a 1-min pre-compression, firing was done as usual in the normal group. In the slow-firing groups, firing was done over a 1-min period. Malformation of staples was evaluated by the degree of wrapping of the legs to the backspan and the degree of leg twisting.

Results: The slow-firing method significantly improved the twist score in Echelon Plus. In contrast, the twist score increased with the slow-firing method in EndGIA. Some staples in Echelon Plus were category Ⅱ or Ⅲ. In addition, all staples on the outside of the tip of stapler were category Ⅱ or Ⅲ. All staples in EndGIA were category Ⅰ. No significant difference in the wrap category was shown by the firing method in both staplers.

Conclusion: The slow-firing method contributed to the better formation of staples with Echelon Plus, but the effectiveness was not recognized with EndGIA. B-shaped staples with less twisting and wrapping are important factors to complete a reliable suture. After understanding the characteristics of various staplers and selecting the appropriate staple height, adding techniques, such as pre-compression and slow-firing methods will lead to a reduction in post-operative complications.

Open Access Original Research Article

Evaluation of Efficacy of Fosfomycin Combined with other Antimicrobials against MDR Proteus Mirabilis In vitro and In vivo

Nafisa Jabin Mishu, H. M. Khaleduzzaman, S. M. Shamsuzzaman, Modina Ansary Nabonee, Nigha Zannat Dola, Azmeri Haque

Journal of Advances in Medicine and Medical Research, Page 129-140
DOI: 10.9734/jammr/2022/v34i2031478

Aims: The aim of this study is to evaluate antibiotic combinations against MDR Proteus mirabilis.

Study Design: This was a cross sectional study.

Place and Duration of Study: Department of Microbiology Dhaka Medical College Dhaka Bangladesh from June 2019 to July 2020.

Methodology: Total 570 urine, blood or wound swab and pus samples were collected from the patients admitted in Dhaka Medical College Hospital after taking informed written consent. Proteus mirabilis were isolated and identified by observing pale of colorless colonies in MacConkey’s agar media and biochemical tests. Antimicrobial susceptibility test of various drugs were done by modified Kirby–Bauer disc diffusion method [1] and zones of inhibition were interpreted according to CLSI guidelines [2]. Escherichia coli ATCC 29212 was used as control strain to assess the performance of the method. Minimum inhibitory concentrations (MIC) of various drugs were determined using agar dilution method [3,4]. To prepare bacterial inoculum, the turbidity of bacterial suspension in normal saline was compared with 0.5 McFarland turbidity standards. Antibiotic combinations of various drugs were used to see synergistic, additive, indifferent or antagonistic effects by agar dilution method both in vivo and In vitro [5].

Results: Out of 44 proteus mirabilis 29 were multidrug resistant (MDR). Among the MDR proteus mirabilis 7(24.14%), 20(68.97%), 11(37.93%) and 13(44.83%) were resistant to fosfomycin, amikacin, piperacilin- tazobactam and tigecycline, respectively. The MIC value for fosfomycin, amikacin, piperacilin- tazobactam and tigecycline ranged from 64 µg/ml to 4096µg/ml, from 256 µg/ml to 16,384µg/ml, from 128/4 µg/ml to 1024/4µg/ml and from 8 µg/ml to 64µg/ml, respectively. Out of 4 fosfomycin and amikacin resistant P. mirabilis, one (25%) had 8 fold reduction of MIC, 3 (75%) had 4 fold reduction of MIC (Table 5). Out of 4 fosfomycin and amikacin resistant strains, all showed synergism in combination as their FICI value were ≤0.50. Out of 4 fosfomycin and tigecycline resistant strains, one had FICI value 0.50 (synergistic), two had FICI value 1 (additive) and one had FICI value 0.25 (synergistic). Out of 4 fosfomycin and piperacillin-tazobactam resistant strains, 2 had FICI value 0.50 (synergistic) and one had FICI value 0.25 (synergistic), one had FICI value 1 (additive). All the mice in the positive control group were bacteramic. All the mice in the negative control were blood culture negative. In the group treated with fosfomycin, 20% were culture negative. In the group treated with tigecycline, piperacillin- tazobactam none was culture negative. In the group treated with amikacin, 20% were culture negative. In the group treated with fosfomycin and amikacin, 100% were culture negative. In the group treated with fosfomycin and tigecycline, 80% were culture negative. In the group treated with fosfomycin and Piperacilin- tazobactam 80% were culture negative. Comparison between synergism of different antibiotic combinations in MDR P. mirabilis in vitro and in vivo was showed in (Table 10). While combining fosfomycin with amikacin, they showed 100% synergistic effect both In vitro and In vivo, while combining tigecycline with fosfomycin, they showed 50% synergistic effect in vitro and 80% synergistic effect in vivo and while combining fosfomycin with piperacillin-tazobactam, they showed 75% synergistic effect in vitro and 80% synergistic effect in vivo.

Conclusion: Combination therapy is good treatment option for MDR P. mirabilis both in vitro and in vivo. Fosfomycin and amikacin was the most effective combination in both in vitro and in vivo which showed 100% synergism. From the present study it appeared that combination of fosfomycin and amikacin may be a good option for treating infection by MDR P. mirabilis.

Open Access Original Research Article

Efficacy and Safety of Intracoronary Administration of Tirofiban through Perforated Balloon Technique in Patients with St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Ahmed Mosaad El-Ghlban, Medhat Mohammed Ashmawy, Hanan Kamel Kasem, Ehab Abd-El Wahab Hamdy, Enas EL-Sayed Dras

Journal of Advances in Medicine and Medical Research, Page 141-150
DOI: 10.9734/jammr/2022/v34i2031479

Objective: To assess the safety and efficacy of intracoronary (IC) versus Intralesional (IL) administration of   tirofiban during primary (PCI) in patients with acute ST segment elevation myocardial infarction.

Patients and Methods: This research involved 95 patients who were randomly assigned to recieve either IC bolus plus maintenance or IL bolus plus maintenance of tirofiban. Both groups were compared for pre and post intervention for cardiac marker, myocardial perfusion, and Major composite adverse cardiac event incidence at 3 months were recorded.

 Results: Incidence of major adverse cardiac events was not different between groups, but Post procedure TIMI flow III and MBG III were significant in IL group with p = 0.03*, and 0.022* respectively favoring distal intracoronary strategy. Peak CK-MB values were lower in IL tirofiban group than IC group, 172.79±18.37, 184.58 ± 19.93 respectively with significant (p=0.021). ST segment resolution and 3 months LVEF in IL group were significantly higher in IL group than in IC group (p= 0.016*) respectively.

Conclusion: local intracoronary tirofiban infusion via perforated balloon technique at the time of PPCI was associated with reduced thrombus burden, improved immediate angiographic outcome, and 3-month EF, compared with intracoronary GPI bolus injection via the guiding catheter.

Open Access Original Research Article

Frequency of Symptoms of COVID-19 Disease among the People of Bangladesh

Tanvir Ahmed, H. M. Khaleduzzaman, Jannatul Ferdos

Journal of Advances in Medicine and Medical Research, Page 165-170
DOI: 10.9734/jammr/2022/v34i2031481

Aims: To find out the differences of symptoms of COVID-19 diseases among vaccinated and unvaccinated individual.

Study Design: This was a cross section type observational study.

Place and Duration of Study: Out door of cost guard Hospital Dhaka Bangladesh from July 2021 to January 2022.

Methodology: Here all persons who were found positive RT-PCR for COVID-19 from July 2021 to January 2022 were included in this study. This study was carried out among people who were serving under Cost guard Bangladesh. Here we had included all persons who became infected with COVID-19 irrespective of sex, ethnicity and vaccination status against COVID-19. Sampling was done by purposive random sampling method. Sample size was 104. Data analysis was done by using SPSS-26.

Results: In this study most of the participants (72.2%) were among 20-39 years age group and 97% were male. There was no specific symptom of COVID-19 rather its presentation mimics many other diseases. Fever (90.4%) and cough (85.6%) were found most common presentation. Other symptoms were sore throat (65.4%), loss of taste sensation (64.4%), headache (54.8%), loss of smell (40.4%), fatigue (36.5%) and loose motion (09.6%). In this study most of the participants (89%) were not vaccinated against COVID-19 before they have been infected with SARS COV-2. In this study we found that most prominent symptoms were fever and cough, of them 13% were vaccinated whereas 87% participants were not vaccinated against COVID-19 infection.

Conclusion: COVID-19 disease affects many part of the body and it’s presentation varies depending its effects on organs. Vaccine is an important invention to combat against COVID-19 though it cannot prevent a person from being infected. Vaccination cannot immune a person from being infected but it significantly reduced symptoms of infection. So vaccinations have beneficial effects.

Open Access Original Research Article

The Effect of Carbetocin versus Misoprostol versus Ergometrine for Controlling Bleeding after Cesarean Section in Primigravidae

Ahmed Hamdy Abdeldayem, Mohamed Mohsen Elnamoury, Ahmed Mohamed Othman, Tarek Mohamed El Sabaa

Journal of Advances in Medicine and Medical Research, Page 171-177
DOI: 10.9734/jammr/2022/v34i2031482

Background: Women undergoing cesarean section have a high risk of blood loss and so are more likely to need a blood transfusion. The aim of this work was to compare the effectiveness of using carbetocin versus misoprostol versus ergometrine for controlling bleeding after cesarean section in primigravidae.

Methods: This prospective randomized clinical trial was conducted on 150 patients aged from18-35 years old, primigravidae with singleton pregnancy undergoing elective cesarean section. Participants were divided into three equal groups: carbetocin group (group C) received a single 1-ml ampoule of carbetocin (100 μg/mL) added to 10 cm saline intravenously following the delivery of the neonate, misoprostol group (group M) received misoprostol 400ug per rectum immediately after induction of anesthesia in operating theater and ergometrine group (group E) received 0.2 mg of ergometrine intramuscularly in the first minute after delivery of the baby.

Results: The amount of blood in suction jar, amount of blood loss, Hb change and HTC change were significantly higher in the misoprostol group and ergometrine group than in the carbetocin group (p <0.05) and in the ergometrine group than the misoprostol group (p <0.001). Post-operative Hb in the ergometrine group was significantly lower in the carbetocin group (p =0.001).

Conclusions: Carbetocin can be considered a superior choice to misoprostol and ergometrine in reducing blood loss during CS in primigravidae.

Open Access Original Research Article

Infection Prevention and Control Practices, and Barriers to Compliance among Medical Doctors and Clinical Medical Students, in a State University Teaching Hospital, Southeast Nigeria

Edmund O. Ndibuagu, Onyinye H. Chime, Chinonyelum J. Orji, Tonna J. Aneke

Journal of Advances in Medicine and Medical Research, Page 178-190
DOI: 10.9734/jammr/2022/v34i2031483

Aim: Objective of study was to assess infection prevention and control practices, and barriers to compliance among doctors, and students in a state university teaching hospital.

Study Design: The study was of descriptive, cross sectional design.

Place and Duration of Study: Conducted in the departments of Medicine, and Surgery, Enugu state University Teaching hospital, Southeast Nigeria. Four weeks in August 2019 was used in collecting data from 61 doctors, and 100 students.

Methodology: Self-administered questionnaire was used in collecting information from respondents, selected through Convenience sampling method. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 22. Results were expressed in frequencies and percentages of responses.

Results: More than 50.0% doctors reported compliance with hand hygiene, face mask use, eye goggle use, protective gown use, head cover use, hand gloves use, and disposal of sharps in Safety boxes. However, 95.1% of doctors recap used needles. Also, more than 50.0% of medical students reported good compliance with the above-stated items except for the use of eye goggles and use of hand gloves when attending to fever patients. Up to 76.0% of students recap used needles. Respectively, 70.5% of doctors and 67.0% of students identified inadequate supply of personal protective equipment as a barrier to compliance with infection prevention and control practices. Also, 67.2% of doctors and 65.0% of students forget to wash their hands as prescribed. 19.7% of doctors and 37.0% of students didn’t know that needles/sharps should be disposed of in safety boxes.

Conclusions: Infection Prevention and Control (IPC) practices are relevant components of the healthcare system, and involve different methods designed to mitigate the risk of spreading infectious diseases in healthcare facilities. Most of the respondents in this study, had good hand hygiene, and personal protective equipment uses and practices, but the embarrassing level of recapping used needle practice.

Open Access Original Research Article

Knowledge and Attitudes of Health Professionals on the Influenza Vaccine

Dimitrios Theofanidis, Antigoni Fountouki

Journal of Advances in Medicine and Medical Research, Page 191-197
DOI: 10.9734/jammr/2022/v34i2031484

Introduction: Seasonal influenza is a condition that can be prevented by vaccination and annual vaccination against influenza is the most effective way to prevent the flu. Vaccination is especially important for people at higher risk of serious influenza complications such as patients with chronic diseases, pregnant women, young children, the elderly and healthcare personnel.

Aim: To investigate the knowledge and attitudes of healthcare professionals towards the seasonal flu vaccination.

Methods: The sample consisted of 120 healthcare workers. This small survey was conducted at a provincial hospital in Greece, where questionnaires were distributed to healthcare professionals on the subject of seasonal flu vaccination. The answers were analyzed by SPPS v.20 and the chi square test was employed for group comparisons. Results were analyzed for gender, age, educational level and occupational status, so that inferences could be made.

Results: 58% of the sample was female and the majority was aged between 31-41 years, while 40% were tertiary education graduates. The majority of the sample was nurses (52.5%). The majority of health professionals involved in our study agreed that vaccination is an important preventive measure for disease, such as seasonal influenza, and consider it dangerous if one is not vaccinated while working in a healthcare facility.

Discussion: The majority of our sample was vaccinated or was to be vaccinated during this survey. In the opinion of health professionals about the seasonal flu vaccine, they find it important to do so with those who come in contact with other people, and especially with patients.

Conclusions: This sample from a Greek provincial hospital was informed about the safety of the seasonal influenza vaccine and thus was happy to have the flu shot. However, further research on this important issue of influenza vaccination is needed.

Open Access Original Research Article

Evaluation of the Serum Zinc Level in Some Pigmentary Skin Disorders

Sally Hosni Ali, Maaly M. Mabrouk, Mohamed M. Fawzy, Rania Ahmed El-Tatawy

Journal of Advances in Medicine and Medical Research, Page 198-206
DOI: 10.9734/jammr/2022/v34i2031485

Background: Pigmentary disorders are a common presentation in dermatology and the appearance of either hypopigmentation or hyperpigmentation can be a major psychosocial problem to the patients. Melanin pigment is the most important substance determining human skin color. It produced by melanocyte cells during melanogenesis. Zinc in combination with other micronutrients has an essential function in melanogenesis process.         

Aim of Work: The aim of the study was to assess serum zinc level in patients with pigmentary disorders compared to healthy control subjects.

Patients and Methods: This study was carried out on a total of 189 patients with pigmentary disorders (96 with hypopigmented and 93 with hyperpigmented disorders) and 50 apparently healthy controls. Serum zinc level was measured in all groups using a Flame Atomic Absorption Spectrophotometer.

Results: The mean serum zinc level was in the hypopigmented, hyperpigmented disorders patients were 71.87 ± 20.23 and 72.36 ± 18.69, respectively, while the mean serum zinc level in controls was 87.48 ± 31.50, with the serum zinc level in patients with hypopigmented disorders was significantly lower than in healthy controls (P < 0.05). The average zinc level in the three groups was found to be within the normal reference range.

Conclusion: Serum zinc level was within normal range in both patients and control groups. On the other hand, serum zinc level in pigmentary disorders was lower than that of control group with a statistically significance difference only between hypo pigmented disorders and control group.

Open Access Original Research Article

Association of Inflammatory Markers and CT Scoring as Severity Predictors in COVID-19 Patients

Abhijeet Lonsane, R. K. Chopra, Mohanakrishnan Jayamani

Journal of Advances in Medicine and Medical Research, Page 207-216
DOI: 10.9734/jammr/2022/v34i2031486

Background: COVID-19 disease caused by SARS CoV-2 has rapidly spread worldwide and became a global concern for human health. Computed Tomography (CT) scan facility is not readily available in remote areas in developing nations like India. Previous studies have revealed the utility of CRP, LDH and other biomarkers in predicting the severity of COVID-19 pneumonia in resource limited settings and thus can help in stratification and early critical care transfer.

Objective: The current study aimed to determine correlation between inflammatory markers with CT severity score to predict extent of COVID-19 pneumonitis. 

Materials And Methods: A total of 240 patients more than 18 years of age hospitalized with COVID-19 confirmed diagnosis either by RT-PCR test or by Rapid Antigen Test were assessed in this monocentric prospective observational study at our center, Pune, India. CT severity score and blood parameters such hemogram, hsCRP, LDH, Ferritin, IL-6 and D-dimer levels documented on the day of admission. The total CT score was the sum of five individual lobar scores and defined as: 0, none; 1–5, minimal; 6–10, mild; 11–15, moderate; and 16–20, severe lung involvement.

Results- Mean age of patient in clinically critical cases (61.40 years) was higher than those with moderate (55 years) and non-severe clinical presentation cases (50.51years). 180 (75%) subjects were having non-severe clinical presentation followed by 31 (12.9%) subjects with severe and 29 (12.1%) subjects were having critical clinical presentation on admission. hsCRP & LDH were having more correlation coefficient with CT severity score (0.599 & 0.570 respectively). The ROC analysis revealed that area under curve for hsCRP and  LDH on the day of hospitalization for predicting severe lung involvement was 0.796 at cut-off of 8.65 mg/dl (Sensitivity 76.9%, Specificity 74.9%) and 0.919 at cut-off of 425 U/L (Sensitivity 84.6%, Specificity 84.1%).

Conclusion: On the basis of strong significant association with CT severity; hsCRP and LDH levels can be used to predict extent of lung involvement in chest CT in COVID-19 disease, thereby it will help in early triage and critical care transfer of patients to ensure optimal resource allocation in peripheral areas with limited facilities.

Open Access Original Research Article

Role of Magnetic Resonance Imaging in Evaluation of Hip and Groin Sports-Related Injuries

Hager Yasser Shahin, Rasha Lotfy Younes, Ahmad El Sayed El Tantawy, Alsiagy A Salama

Journal of Advances in Medicine and Medical Research, Page 217-226
DOI: 10.9734/jammr/2022/v34i2031487

Background: Magnetic Resonance Imaging (MRI) proved to be highly accurate imaging modality allows clear differentiation of the normal anatomic features of the hip. In addition to that it allows clear differentiation of the individual component of the normal joint from one another. The purpose of this work was to diagnose sports-related injuries of hip and groin using MR imaging with different sequences.

Methods: This prospective study was carried out on59 athletic subjects presented clinically with different hip or groin joint complaints, both sexes within adult age. All patients were subjected to clinical examination, imaging (conventional radiography of both hips were performed mostly in antero-posterior and lateral views to detect fractures, dislocations, bony lesions or soft tissue swelling), MRI examinations and image analysis.

Results: There was significant difference between MRI type of injuries and different age groups of studied sportive patient. MRI show lesion in 59 cases in comparison to X-ray which has less sensitivity as 46 case has negative results show lesions in MRI.

Conclusions: MRI of the hip has established to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs, also it can determine early signs of stress fracture before it appear in X-ray. so, more details about different lesions can be obtained from MRI and This help in accurate diagnosis, rapid treatment of different athlete lesions and determine time plane of returning to the sport by follow up imaging.

Open Access Original Research Article

Evaluation of Rapid Ultrasound in Shock and Hypotension (RUSH) in Blunt Polytrauma Patients

Zain El-Abidine Kamal Badr, Wesam Ibrahim, Mohammed Samy Sharf, Mahmoud Ahmed Elafifi

Journal of Advances in Medicine and Medical Research, Page 227-233
DOI: 10.9734/jammr/2022/v34i2031488

Background: The leading cause of death in the first 4 decades of life is trauma, and it remains a serious public health concern in all countries, whether rural or urban areas. While in Egypt damage is several times higher because of misclassification and under-reporting. The aim of this research was to compare between POCUS and other traditional imaging (x-ray, CT) in diagnosis of shock following blunt polytrauma patients and evaluate RUSH protocol in diagnosis of shock and follow up.

Methods: This prospective research was conducted on 100 patients aged from 18 to 65 years old, with blunt polytrauma presented with shock and hypotension. All patients underwent full history taking, and radiological investigations when needed, clinical examination according to Advanced Trauma Life Support (ATLS), management was consisted of primary and secondary survey, routine laboratory investigations and RUSH assessment for trauma.

Results: Systolic and diastolic blood pressure, respiration rate and heart rate were significant clinical predictors of shock. The time taken by RUSH protocol to assess shock was significantly lower compared to the time taken by Pan-CT and X- rays (P < 0.0001).

Conclusions: This study has focused on the point-of-care ultrasound (RUSH protocol) role for the early identification of the causes of shock in the department of emergency medicine. Diagnosis made by RUSH protocol is strongly agree with right medical diagnosis. It demonstrates the high efficacy of (RUSH protocol) in detecting and classifying distinct types of shock aetiology with high accuracy.

Open Access Original Research Article

Management Strategies of Acute Bacterial Rhino Sinusitis

Eslam Mossa Mossa Shabaka, Mohamed Abd Al Rahman Amer, Fathy Aly Arfan, Mohamed Hamed Askar

Journal of Advances in Medicine and Medical Research, Page 234-239
DOI: 10.9734/jammr/2022/v34i2031489

Aims: The aim of the work is to compare 3 different Guidelines for Management of ABRS and determine the most appropriate Guideline to be adopted by the Egyptian patients.

Methodology: This was a prospective study conducted on 90 consecutive patients selected from the outpatient clinic of Otorhinolaryngology department at Tanta university hospital within the period from December 2019 to December 2020.

Results: The Arabic version of nose scale distribution among studied groups before and after intervention. Before intervention, there were no statistically significant differences among the three studied groups and among each other’s (P>0.05). After intervention, there were highly statistically significant differences among the three studied groups and each other’s (P<0.001) being highly decreased in group 2 followed by group A and lastly group C. Paired t test demonstrated highly statistically significant difference before and after intervention in the three studied groups (P<0.001).

Conclusion: In conclusion, the current study reported that, the three approaches demonstrated promising outcomes for management of ABRS in terms of SNOT as well as Arabic version of nose scale. However, Epos 2020 Guidelines of ARS were demonstrated to be associated with the most promising ones.

Open Access Original Research Article

Comparison of Percent Positivity of Two Districts of Kashmir during the 3rd COVID Wave

Jalila Qayoom, Omar Rashid, Talat Masoodi, Umar R. Khan, Syed Arshi

Journal of Advances in Medicine and Medical Research, Page 240-245
DOI: 10.9734/jammr/2022/v34i2031490

Background: SARS CoV-2 virus is the infectious agent that causes COVID-19 infection. The majority of those who contract this virus experience mild to moderate respiratory illnesses. This infection affected the entire population of India. The infection ratio (IR) of COVID-19 can be calculated by comparing the % positivity of various districts in a State/UT, which may prove crucial for developing policies and in taking necessary interventions for future.

Objective: The present study aimed to investigate the district level variation of COVID-19 infection in Kashmir during December 2021 and January 2022. The present study also gives the percent positivity of the COVID-19 infection at the various district levels.

Data and Methods: This study was retrospective in nature. The data was collected from COVID-19 lab of SKIMS Medical college and hospital (SKIMS MCH), Bemina and analysed.

Results: The total samples received in the month of December 2021 and January 2022 during 3rd COVID-19 wave from 2 districts in SKIMS MCH, Bemina,Srinagar was 56279. Out of these samples, 34141 was from district Kupwara and 22138 was from district Srinagar. The percent positivity for both months of December and January was more in district Srinagar i.e 11.4% and 3.8% respectively as compared to district Kupwara  which was 8.7% and 2.9% respectively. From district Srinagar, the samples were received from 4 different regions i.e, Batmaloo, Tourist reception centre (TRC), SR gunj and Khanyar.The percent positivity in the month of December 2021 for various regions from district Srinagar i.e, Batmaloo, TRC, SR gunj and Khanyar was 4.1%, 5.2%, 2.9% and2.8% respectively. The percent positivity  in the month of January 2022 for various regions from district Srinagar i.e, Batmaloo, TRC, SR gunj and Khanyar was 12.6%, 21%, 7.9% and 8.0% respectively.

Conclusion: The district Srinagar showed more cases of COVID-19 infection as compared to district Kupwara. This study provided the crucial information for the policies discourse and giving special attention to the vulnerability of the highly urban area.

Open Access Original Research Article

Hang-Back Technique versus Conventional Lateral Rectus Recession in Exotropia

Amira Abou-Elnaga Elamary, Heba Mohamed Shafik, El-Sayed Samir Arfa, Ahmed Lotfi Ali

Journal of Advances in Medicine and Medical Research, Page 246-254
DOI: 10.9734/jammr/2022/v34i2031491

Background: Exotropia is a type of eye misalignment. About 90 % of all exodeviations are intermittent exotropia. Management options are non-surgical as correction of refractive error and surgical, here we discussed two surgical techniques: the conventional recession and the Hang-back recession. This study evaluated the result of both techniques in management of exotropia and investigate the longitudinal change in the lateral rectus muscle insertion by AS-OCT imaging of the muscle new insertion site.

Methods: The prospective randomized study included 40 eyes with exotropia. All cases underwent two types of surgery (the conventional recession and the Hang-back recession) and complete ophthalmological and strabismus examination before and after surgical treatment and completed six months follow up at one day, one week, one month, three months, six months.

Results: The success rate for conventional recession technique was 85%. There was no consecutive esotropia as a complication, but a long period of follow up may show delayed consecutive esotropia. There were no significant complications as slipped muscles or infection.

Conclusions: Conventional recession and hang back technique are two surgical options for lateral rectus muscle recession, results of both techniques are compared. The result showed that conventional recession technique success rate is higher than the hang back technique. Our study showed the effectiveness of both techniques as there were no cases that showed limitation of abduction.

Open Access Original Research Article

A Comparative Study of the Performance of Typhoid Diagnostic Tests among Suspected Patients at the University of Cape Coast Hospital, Ghana

James Kojo Prah, Samuel Amoah, Cecil Banson, Benjamin Nyane, Rudolf Aaron Arthur, Godfrey Yeboah Amoah, Isaac Derban, Sobre Kwasi Nkrumah, Isaac Dadzie, Irene Esi Donkoh

Journal of Advances in Medicine and Medical Research, Page 255-266
DOI: 10.9734/jammr/2022/v34i2031492

Introduction: the World Health Organization recommends that the gold standard for diagnosing typhoid fever is the use of blood cultures. However, under real-world conditions in low-resource settings, there are lack of culture facilities as well as expertise, and usually, patients report late after prior antibiotic exposure. This study sought to evaluate the performance of typhoid rapid diagnostic tests, blood, and stool cultures as well as polymerase chain reaction (PCR) under such settings.

Methods: This cross-sectional study involved the use of blood and stool samples from 400 consenting outpatients suspected of typhoid fever by attending clinicians at the University of Cape Coast Hospital, Ghana.

Results: out of the 400 participants, 171 (42.8%) tested positive to at least one of the RDTs. Even though many of the participants had a history of fever, all of them were afebrile as none presented with a temperature of 380C and above. There was a high (48.0%) history of antibiotic use within two weeks before presentation. No participant was a culture or PCR positive for S. typhi and paratyphi. However, in 7(1.8%) participants, other salmonella species were detected by PCR. Also, citrobacter and proteus vulgaris were cultured in 13(3.3%) and 10(2.5%) participants respectively using stool samples. In blood samples, there was a 7(1.8%) growth of Staphylococcus aureus.

Conclusion: under real-world conditions where patients usually present without typical symptoms such as high temperatures probably after prior antibiotic use, cultures and PCR perform poorly. There is therefore a need for further studies aimed at improving the yields of these important diagnostic tests in such settings.

Open Access Original Research Article

Cardiac Electrical Changes during Co-administration of Artemether-lumefantrine and Atazanavir/Ritonavir in HIV-infected Nigerian Adults

Kareem Lookman Olalekan, Adedapo Aduragbenro A. D. A., Kareem Rafiat Adeola, Falade Catherine O.

Journal of Advances in Medicine and Medical Research, Page 267-275
DOI: 10.9734/jammr/2022/v34i2031493

Background: Malaria and HIV infections are both major public health problems in Africa with significant morbidity and mortality. Atazanavir and artemether-lumefantrine are used in the treatment of HIV and Malaria respectively which are co-administered when there is co-infection with both diseases. Both drugs are known to independently cause cardiac electrical abnormalities. In addition, atazanavir inhibits CYP3A4 which is the enzyme that metabolizes lumefantrine with the potential for increased cardiac electrical abnormalities. We, therefore, assessed the cardiac electrical activities during the co-administration of atazanavir and artemether-lumefantrine.

Method: Forty-one consecutive HIV-infected adults attending the Anti-retroviral therapy clinic in a Nigeria General hospital were enrolled on the study using the convenience sampling technique. Study participants had electrocardiographic tracings done before (day 0) and after treatment with artemether/lumefantrine (days 3 and 7).

Result: There was an increase in the mean heart rate from day 1 through day 7 but the mean heart rates were within normal limits. In contrast, there was a progressive decline in the mean PR interval from day 0 through day 7 which was not statistically significant. There was also a significant increase in corrected QT interval (QTc) between day 0 and day 3 and day 0 and day 7. Though the value of the mean QTc on day 3 (414.83±34.88ms) and day 7 (411.41 ± 22.63ms) remained within the normal limit, 5% (2) of the participant had prolonged QTc.

Conclusion: The results of this study suggested that there may be potential drug-drug interaction resulting from the co-administration of atazanavir based antiretroviral drug and artemether-lumefantrine especially in the prolongation of QTc interval.

Open Access Original Research Article

Effect of Lactoferrin Administration on Serum Iron Status of Children on Regular Hemodialysis

Marwa Abd El-Salam Ibrahim Turky, Amal Said El-Bendary Saad, Ibrahim Mohammed Badraia, Maher Ahmed Abd El-Hafez

Journal of Advances in Medicine and Medical Research, Page 289-301
DOI: 10.9734/jammr/2022/v34i2031497

Background: This study aimed to evaluate the effect of lactoferrin administration on serum iron status of children on regular hemodialysis.

Methods: This case-controlled study was carried on 60 children with end stage renal disease on regular hemodialysis and 30 healthy children served as a control group. Patients were classified into 2 groups, group A: 30 patients received oral lactoferrin supplementation 100 mg for 3 months and group B: 30 patients received oral lactoferrin supplementation plus oral iron 5mg/kg/day for 3 months. Serum ferritin, transferrin saturation (TSAT), serum hepcidin and IL6 were measured before and after supplementation

Results: Serum ferritin was significantly higher in patient groups compared to controls before the supplementation (P <0.001) but significantly decreased after supplementation (P= <0.001). No significance difference between patient groups in serum ferritin levels before or after the supplementation (P=0.778, P=0.763) respectively. TSAT was significantly lower in patients groups compared to controls before the supplementation (p<0.001) but showed significant decrease after supplementation in group A (P=0.036) and significant increase in group B after the supplementation (P<0.001). TSAT was significantly increased in group B compared to group A (P<0.001). Serum hepcidin and serum interleukin 6 levels were higher in patients than controls before supplementation but significantly decreased at the end of the study in patient groups. . There were positive correlations between serum hepcidin and interleukin 6, CRP, and ferritin levels but a negative correlation with hemoglobin and TSAT. There was a positive correlation between serum IL-6 and both CRP and ferritin but a negative correlation between IL-6 and both Hb and TSAT.

Conclusions: Oral lactoferrin was not able to maintain iron status in HD children while Lactoferrin plus oral iron was effective in treating iron deficiency in HD patients.

Open Access Original Research Article

Study of Cognitive Function in Patients with Chronic Obstructive Pulmonary Diseases

Eman Abdel Hakim Abo El-Enein, Reham Mohammed El-Kolally, Mai Abd El-Raouf Issa, Ghada Atif Attia

Journal of Advances in Medicine and Medical Research, Page 309-318
DOI: 10.9734/jammr/2022/v34i2031500

Backgrounds: Cognitive impairment is a frequent feature of COPD, so Cognitive function study should be a part of the initial respiratory assessment in COPD patients especially for those patients presenting with evident or self-reporting symptoms of cognitive deficit.

Objectives: The aim of our work was to study the cognitive function among COPD patients by using specific cognitive function tests and to assess the validity of these tests in detecting this impairment among COPD population.

Subjects and Methods: A cross sectional observational study was carried out on 100 patients with COPD diagnosed according to Global initiative for Chronic Obstructive Lung Disease [1]  Subjects of the study were selected from Chest Department Outpatients Tanta University Hospitals and Mansoura Chest Hospital Outpatients between March 2019 and November 2020. They were divided into three groups; group I including 34 grade II COPD patients, group II including 32 grade III COPD patients and group III including 34 grade IV COPD patients.

Results:  Half of group III patients had severe cognitive impairment compared to 34.4% among group II patients and 26.5% among group I patients with a statistically significant differences in the MMSE between the three studied groups. (x2 =9.699, p=0.015). Group III patients had 29.4% with severe impairment, while group II had 34.4% and group, I had 17.6% with severe impairment with a statistically significant difference in digit symbol test distribution between different studied groups. As regards to Trail A and B tests, group III had high percent impaired test results, compared to group I and II with a statistically significant differences in its distribution between the different studied groups. As regards to Digit Span Tests A and B, there was no statistically significant difference in its distribution between different studied groups.

Conclusions: The Mini Mental State Examination Test may be used as a part of the initial respiratory assessment to give an idea about the cognitive state of the patient and if the patient needs more care for his cognitive status or not.

Open Access Original Research Article

Drug Utilization Evaluation in COVID- 19 Hospitalized Patients: A Retrospective Study

K. V. Ramanath, Sharvari Venugopal, A. Shadakshari, Nimesh Kumar Pradhan, B. Abinavi, Harsharan Kaur, Leeba Jacob

Journal of Advances in Medicine and Medical Research, Page 319-337
DOI: 10.9734/jammr/2022/v34i2031501

Introduction: Corona disease 2019 (COVID-19) is an airborne viral infectious disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) mutant. Transmission can occur if splashed or sprayed with contaminated fluids in the eyes, nose, or mouth, and, rarely, via contaminated surfaces. Symptoms are slightly variable with the mutants, and the general is fever, cough, headache, fatigue, breathing difficulties, and loss of smell and taste. The co-morbid diseases like cancer, cardiovascular disease, diabetes, hypertension, and chronic respiratory disease & the elderly are more likely to develop severe illnesses. The standard diagnostic method and treatment pattern varies from hospital to hospital, provokes to carry out this project. 

Objectives: To assess the drug treatment pattern, antibiotic usage patterns, and cost, determine the antiviral usage pattern and its price. Estimate anti–interleukin-6 receptor monoclonal antibody (Tocilizumab) usage and cost.

Methodology: A retrospective observational study was conducted in Sagar Hospitals, Kumaraswamy Layout, Bangalore, for six months after obtaining ethical clearance using a well-designed questionnaire.

Results and Discussion: 155 Cases were collected from the medical records department. The most widely used antibiotic was Ceftriaxone, 60.6%, a cell wall synthesis inhibitor, followed by Azithromycin, 59.4%, a protein synthesis inhibitor. The most widely used antiviral was Oseltamivir in 51.6%, Remdesivir in 41.3% of patients, and Favipiravir in 12.3%. Other co-morbid drugs are corticosteroids, immunomodulators, mucolytics, antihistamines, blood thinners, and anti-helminthes. The mean cost of the antibiotics and antiviral are 224 ± 295.73; 1623.28 ± 2047.45.

Conclusion: This study showed that in the management of COVID 19, ICMR Guidelines were adopted. The cost of the drugs also played a significant role in selecting treatment regimens, especially antibiotics, antiviral, and immunomodulators. Hence the cost consideration studies may help in Rational drug usage promotion and cost-minimization in disease management.

Open Access Original Research Article

Optimal Morphological Criteria Evaluated by Intravascular Ultrasound to Predict Future Clinical Outcomes in the Complex Percutaneous Coronary Intervention Lesions

Hanan Saad Salem, Atul Mathur, Ehab Abdel Wahab Hamdy, Hanan Kamel Kassem, Mai M. Abdel Moniem Salama, Seham Fahmy Badr

Journal of Advances in Medicine and Medical Research, Page 338-348
DOI: 10.9734/jammr/2022/v34i2031502

Background: Intravascular ultrasound (IVUS) guidance of stent implantation can help optimal stent deployment in comparison to angiographic guidance alone. Thus, IVUS guidance might enhance short and long-term clinical outcomes of cases performing percutaneous coronary intervention (PCI). The purpose of this work was to investigate the optimal morphological criteria evaluated by IVUS to predict the clinical outcomes in PCI of complex lesions.

Methods: This observational prospective study was carried out on 56 patients who underwent PCI for complex coronary lesions guided by IVUS. All patients were subjected to standard 12- lead electrocardiogram (ECG), routine laboratory examinations [complete blood count (CBC), blood urea and serum creatinine, prothrombin time, and international normalized ratio (INR)], echocardiography, coronary angiography, PCI and IVUS guidance (both pre and post stenting).

Results: 7 of 45 cases with coronary bifurcation lesion (CBL) were treated with a two-stent technique that was planned upfront in 5 of them and was applied as a bail-out strategy in 2 cases. Whereas, in the remaining 38 cases, provisional stenting strategy was adopted and ended up with one-stent technique that went smooth and uneventful as guided and optimized by adjunctive IVUS. Only one patient (2%) had a non-fatal myocardial infarction 4 months post-index procedure. No incidence of other composite endpoint was encountered during the 6 months follow-up period of the study.

Conclusions: Intravascular ultrasound (IVUS) guidance is associated with favourable procedural and clinical results for cases undergoing complex PCI procedures. This well-established evident role of IVUS in complex PCI procedures is driven mainly by the insights it offers that help better upfront procedural planning in addition to acute procedural result optimization.

Open Access Original Research Article

Association between Vessel Density and Visual Acuity in Patients with Diabetic Retinopathy

Walaa Abdelnaeem Ahmed, Sharif Yousef El-Emam, Mostafa Abdellatif Mahmoud, Yasser Ragab Serag

Journal of Advances in Medicine and Medical Research, Page 359-369
DOI: 10.9734/jammr/2022/v34i2031504

Background: In the non-proliferative stage, diabetic retinopathy (DR) is a retinal vascular disease. Characterised by the formation of micro aneurysms, retinal haemorrhages, exudates, venous alterations, and capillary non-perfusion.  With the usage of optical coherence tomography angiography (OCTA), the purpose of this study was to determine the correlation between vessel density and best corrected visual acuity (BCVA) in DR patients.

Methods: This prospective observational research was done on 50 eyes of 35 consecutive diabetic patients who were diagnosed with mild, moderate or severe non-proliferative diabetic retinopathy (NPDR) and patients with proliferative diabetic changes (as NVD and neovascularization elsewhere (NVE)) as well as a control group consisting of 20 eyes of 10 healthy age-matched participants. Participants were divided into two groups: group A (diabetic patients): sub divided group A1: 40 eyes diagnosed with NPDR and A2: 10 eyes diagnosed with proliferative diabetic retinopathy (PDR) and group B (control group): 20 healthy eyes of age matched participants as a control group. All the eyes were subjected to fund us fluoresce in angiography (FFA) and OCTA. Comparison was made between the vascular density index (VD) in the different slaps between NPDR and PDR group, as well as correlation between the VD and BCVA.

Results: Significant positive correlation was observed between visual acuity (Log MAR) and vascular density index of superficial layer, deep layer in NPDR group and PDR group. Significant positive correlation was observed between vascular density index of superficial, deep layer and best corrected visual acuity (BCVA) (Log MAR) in NPDR group and PDR group.

Conclusions: Using OCTA enhance our awareness of the micro vascular alterations found in DR and allow assessment of disease severity.

Open Access Original Research Article

Prevalence, Patterns and Predictors of Status Disclosure amongst HIV Clients Accessing Care in a Tertiary Health Facility in Nigeria

Elessa Ebot Mary Almond, Aniwada Elias Chikee

Journal of Advances in Medicine and Medical Research, Page 370-382
DOI: 10.9734/jammr/2022/v34i2031505

Introduction: Mankind has been battling the AIDS pandemic since its advent in the eighties. So far, diverse measures have been taken and strategies formulated to combat the disease one of which is geared towards establishing barriers to its spread. HIV status disclosure as a preventive tool amidst other strategies is key to achieving the end AIDS goal by 2030. The study aims to determine the prevalence, patterns and factors associated with HIV disclosure among HIV clients accessing care in the ART clinic of the University of Nigeria Teaching Hospital, Enugu.

Methods: A cross sectional analytical survey was conducted among 260 HIV seropositive clients using interviewer administered questionnaires. Simple random sampling was carried out.  Ethical issues were considered. Data were analyzed using IBM SPSS and summarized using proportion, percentages and mean. Pearson Chi-square test was used for associations at significant level of p ≤ 0.05.

Results: All participants chosen for the study responded (100%). The survey revealed that; 96.5% of the respondents had disclosed their status to someone, 82.7% to their relative/friend. For clients who had spouse/partner, 91.4% have informed them. Majority had disclosed to more than one person (74.6%). There was a relationship between gender (p = 0.031), length of on treatment (p = 0.009), parity status (p = 0.049), think it is important to disclose (p = 0.000) and years of diagnosis (p = 0.003) with disclosure status.

Conclusion: Prevalence of disclosure was high.  Characteristics of participants were associated with status disclosure. HIV disclosure though good but need to be sustained or improved as it is key to HIV control.

Open Access Original Research Article

Alterations in Blood Thyroid Hormone Levels on Palpation of Thyroid Gland

Mukherjee Ankita Atin, Indranil Pal, Saumitra Kumar, Mrityunjoy Halder, Ritesh Singh

Journal of Advances in Medicine and Medical Research, Page 383-388
DOI: 10.9734/jammr/2022/v34i2031506

Introduction: Manipulation of the thyroid gland leads to alteration of thyroid hormones levels. As palpation is the commonest form of manipulation during clinical examination of thyroid gland, its effect has been studied here.

Objective: As various factors influence the serum thyroid hormone levels, our aim was to find out whether palpation of thyroid gland during clinical examination altered its levels or not.

Methods: The blood samples of 89 (85 females ;4 males) patients were collected twice after a gap of 120 minutes following palpation of the gland in the test group and without palpation in the comparison group by the same examiner and at fixed hours to estimate Free Thyroxine (FT4), Free Triiodothyronine (FT3) and Thyroid Stimulating Hormone (TSH) levels.

Results: Serum FT4 level decreased significantly (p<0.05) 2 hours after palpation only in euthyroid patients but hypothyroid or hyperthyroid patients had no significant (p>0.05) change in the serum thyroid hormone levels.

Conclusion: There is statistically significant fall in serum FT4 levels 2 hours after palpation of thyroid gland among euthyroid subjects which is very small to alter the clinical picture.

Open Access Original Research Article

Prevalence and Determinants of Punctal Occlusion at Ophthalmology Outpatient Clinic at Tanta University Hospital

Eman Mostafa Ahmed Mohamed, Amr Mahmoud Awara, Mohamed Ashraf Eldsouky, Osama Elsaid Shalaby

Journal of Advances in Medicine and Medical Research, Page 389-396
DOI: 10.9734/jammr/2022/v34i2031507

Background: Along with canalicular or nasolacrimal duct blockage, punctum stenosis is one of the most common causes of epiphora. The purpose of the study was to investigate the prevalence of punctal occlusion outlining their presentation varieties and etiological factors.

Methods: This cross-section observational study conducted on 50 patient suffering from epiphora. Patients were divided into two groups: single cause(N=19) and combination of causes (N=31). Every patient underwent: taking of the history, examination (examination of the eyelids, lid closure and lagophthalmos), evaluation of the punctum (by usage slit light for visibility, appearance and the occurrence of inflammation or oedema). Schirmer, I test used for ocular surface examination.

Results: Occlusion was significantly higher in single cause than combination of causes while stenosis was significantly lower in single cause than combination of causes groups. Grades of stenosis were significantly different between the two groups. Schirmer test, lower tear meniscus height, and side of lesion were insignificantly different between study groups.

Conclusions: Punctal stenosis was an extremely frequent finding in individuals suffering from epiphora. Age tended to augment the prevalence of punctal stenosis, and many patients accompanied by post-cataract surgery combined with blepharitis then topical anti-glaucoma eye drops with recurrent conjunctivitis were most common association with punctal stenosis patients who had combination of causes.

Open Access Original Research Article

Insertion of Tunneled Hemodialysis Catheters by Exchange over the Guidewire and De Novo Puncture

Eslam Adel Ramadan El Shanshoury, Emad Mohammad Sallam, Mohammed Hamdy Abo-Ryia, Adel Husseiny Kamhawy

Journal of Advances in Medicine and Medical Research, Page 397-406
DOI: 10.9734/jammr/2022/v34i2031509

Background: This study evaluated the safety and efficacy of insertion of tunneled hemodialysis catheters by de novo insertion technique and over the wire exchange technique

Methods: This prospective study included 50 patients with ERSD in need for tunneled hemodialysis catheters insertion. Patients were divided into 2 groups (the first group) 22 de novo insertion of tunneled dialysis catheters and (the second group) 28 over the wire exchange. Patients were subjected to history taking, thorough clinical examination, routine preoperative investigations, preoperative and postoperative X-ray on the neck and chest and Duplex scan of neck veins on both sides.

Results: In the de novo group, 11 patients were inserted by ultrasound guide and 11 patients were inserted by blind anatomical landmark technique in which the ultrasound guided technique showed lower rate of complications, while all over the wire group were inserted ultrasound guided. The primary patency was higher in the over the wire group(after 1 month=96%, after 3 months=89.2%, after 3 months=85.7%) than the de novo group(after 1m, 3m, 6m equals 86.3%,81.8%, 77.2% respectively) with non-significant P value 0.43, hematoma formation was higher in the de novo group with non-significant P value, 3 patients  (13.6%) had infected catheters in the de novo group while 4 (14.3%) patients were affected in over the wire group, with 4 (18.2%) cases were malfunctioning in the de novo group while 3 (10.7) malfunctioning catheters in over the wire group with statistically non-significant P value in these values.  There was significant difference between the 2 techniques in the operative time, for de novo insertion of tunneled dialysis catheters mean operative time was = 27.78 ± 5.71 minutes and in over the wire group the mean operative time was = 15.07 ± 1.98 minutes with statistically significant P value <0.001*.

Conclusions: By comparison between the two methods of tunneled dialysis catheters insertion in ESRD patients (de novo insertion and over the wire exchange technique), we found that over the wire exchange technique can safe time, effort, reduce the rate of operative complication especially hematoma formation and at the same time it showed higher patency rate in comparison to de novo insertion method.

Open Access Original Research Article

Cytokines (IL-17, IL-23 and IL-33) in Adult Patients with Systemic Lupus Erythematosus in Trinidad and Tobago

Angel Justiz Vaillant, Patrick E. Akpaka

Journal of Advances in Medicine and Medical Research, Page 407-413
DOI: 10.9734/jammr/2022/v34i2031510

Systemic lupus erythematosus (SLE) is the most common autoimmune disease. It is characterized by the presence of hundreds of autoantibodies against many organs and tissues, including the presence of a large number of autoantibodies, which are specific to self-antigens mainly of nuclear origin such as Smith antigen, double-stranded DNA (dsDNA), anti-Sjögren’s syndrome-related antigen A and B (SSA/Ro and SSB/La, respectively) and ribonucleoproteins, which are the hallmarks of the disease. Type I and II interferons, interleukin-6 (IL-6), IL-1, tumor necrosis factor-alpha (TNF-α), and immunomodulatory cytokines such as IL-10 and TGF-β are essential players in SLE. Additionally, T-cell-derived cytokines such as IL-17, IL-21, and IL-2 are dysregulated in SLE. In this study among cohorts of 60 individuals attending the hospital clinics in Trinidad and Tobago, blood samples were analyzed and the levels of the essential cytokines were measured using SLE Disease Activity Index (SLEDAI) 2000 score. The results confirmed that serum IL-17 and IL-23 levels were positively correlated with the SLE Disease Activity Index (SLEDAI) 2000 score in these patients. These findings have diagnostic and therapeutic implications. However, more work must be done targeting other cytokines relevant to autoimmunity and SLE in particular. Interleulin-33 is not an SLE marker, as has been noted in other populations.

Open Access Original Research Article

Prescription Non-steroidal Anti-inflammatory Drugs: Pattern and Nephrotoxicity

P. K. Uduagbamen, F. O. Soyinka, A. O. Adebola-Yusuf, M. U. Thompson, S. I. Ahmed, B. A. Alalade, N. O. Boco, T. O. Binuyo, G. C. Oyiogu

Journal of Advances in Medicine and Medical Research, Page 414-426
DOI: 10.9734/jammr/2022/v34i2031511

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are very common “over-the-counter” commonly abused drugs used in treating fever, pain and inflammatory conditions. They inhibit prostaglandins and can cause kidney disease and hypertension, particularly in stressed states like dehydration and exercises.

Objectives: To access prescription pattern and effects of common NSAIDs on the kidneys.

Methods: One hundred frequent NSAIDs users (daily use > 4 weeks) and 100 healthy controls, who had no known risk factor for kidney disease and gave consent were recruited. Blood samples for serum electrolytes, urea and creatinine, haemoglobin concentration and urine samples for dip strip, and 24 hour protein were collected and analysed.

Results: The mean age of the controls, all NSAIDs users, NSAIDs users without kidney dysfunction (KD) and NSAIDs users with KD were 46.04 + 14.21 years, 46.5 + 14.2 years, 41.84 years + 14.52 yrs and 63.04 + 4.21 years respectively, P=0.03. The mean estimated glomerular filtration rate (eGFR) was significantly lower in frequent NSAIDs users than controls, P<0.001. Ibuprofen was the most nephrotoxic and, nephrotoxicity was positively related to combination therapy (P<0.001) and duration of use (P=0.03). Herbal medicines significantly increased the risk of KD, P=0.01. Predictors of KD were advancing age, longer duration of NSAIDs use, Ibuprofen use and combined NSAIDs.

Conclusion: Frequent NSAIDs use, common in Orthopaedic units, could be complicated by kidney dysfunction. Ibuprofen, followed by ketoprofen, was the most nephrotoxic. Observed risk factors for NSAIDs induced nephrotoxicity included advancing age, herbal remedies, Ibuprofen and combination therapy.

Open Access Original Research Article

Population Growth Rates and Pattern of COVID-19 Deaths Per Million

Tareef Fadhil Raham

Journal of Advances in Medicine and Medical Research, Page 432-443
DOI: 10.9734/jammr/2022/v34i2031514

Background: Population growth rate (PGR )can reflect the age group structure of the community because low PGR usually indicates low birth rate and old age structure of the community. As PGR is a single easily recalled from public sources (unlike the age distribution), we designed this study to look for any relation between PGR's impact on COVID-19 mortality and looking for a new indicator for COVID-19 mortality risk assessment. The importance of this study is to study the relation between COVID -19 pandemic and the universal trend in decreasing PGRs and continual change in population structure.

Methods: Ninety-two countries with a total population of more than ten million people were chosen as a sample for this study. We used publically available data for PGRs and COVID-19 deaths per one million populations. These countries were classified into three groups according to COVID-19 death rate per million people as follows: < 1000 / (62 Countries), COVID-19 death rate 1000-2000 (11 Countries), and > 2000 (19 Countries).

Analysis of variance (ANOVA) was used as a statistical method to provide information about levels of variability within a regression model and form a basis for testing the fitted logarithmic model for significance.

Results: PGR was inversely related to COVID-19 mortality in a too highly significant association (p-value 0.000).

Conclusion: We described a novel method to predict countries at increased risk for COVID-19 death through PGR estimation. Low PGR is correlated with the increased COVID-19 mortality rate for COVID-19 and vice versa.

Open Access Original Research Article

Sudden Unexpected Natural Deaths of Adults in Southeastern Nigeria: A 12 Years Autopsy Review

Francis Ikechukwu Ukekwe, Nkiruka Nnonyelum Odunukwe, Daniel Bankole Olusina, Okechukwu Charles Okafor, Martin Arinzechukwu Nzegwu

Journal of Advances in Medicine and Medical Research, Page 444-455
DOI: 10.9734/jammr/2022/v34i2031515

Background: Sudden unexpected natural death (SUND) though a global health problem continues to pose serious challenges in our environment. Evaluation of the causes and risk factors will provide baseline data for planning and implementation of desired urgent interventions.

Objectives:  To determine the patterns of adult sudden unexpected natural deaths in southeastern Nigeria.

Methods: This is a twelve years retrospective descriptive review of sudden unexpected natural death cases at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria from the year 2007 to 2018. Data from the case notes and autopsy reports of these cases were collected and analyzed.

Results: One hundred and two (102) SUNDs were identified constituting 13.6% of all autopsies done in our hospital during the twelve years period under review. There were 76 (74.5%) males and 26 (25.5%) females giving a ratio of 2.9: 1, and a mean age of 48.2 years ± 16.0 SD. Cardiovascular disease (26.5%) was the commonest cause of SUNDs followed by respiratory (21.6%), central nervous system (16.7%), gastrointestinal system & liver (12.7%), cancer related (8.8%), renal (7.8%), diabetes complications (3.9%) and miscellaneous (2.0%). The major specific causes were Hypertensive heart disease (16.7%), pneumonia (6.9%), subarachnoid hemorrhage (5.9%), and aspiration pneumonitis (5.9%). Most SUNDs (13.7%) peaked bi-modally in the 36-40yrs and 61-65yrs age groups. Hypertension (25.5%), cancer (8.8%), and nonspecific bacterial infections (8.8%) were the most prevalent risk factors identified.

Conclusion: Cardiovascular, respiratory, and central nervous system disorders are the major group causes of adult SUNDs in southeastern Nigeria with hypertensive heart disease being the predominant specific cause occurring mostly in middle aged married men. Identifying high risk patients of hypertension could allow for timely interventions and prevention of sudden death.

Open Access Original Research Article

Effect of Laparoscopic Ovarian Cystectomy of Endometriotic and Non-Endometriotic Cysts on Ovarian Volume, Ovarian Reserve and Ovarian Doppler Velocimetry

Ahmed Salah Abo Elagha, Aymn Shehata Dawood, Shahenaz Hamdy Elshorbagy, Ashraf Elmohamady Ghareeb

Journal of Advances in Medicine and Medical Research, Page 461-469
DOI: 10.9734/jammr/2022/v34i2031517

Background: Laparoscopic ovarian cystectomy (LOC) is one of the most often performed and simplest gynaecological procedures. The aim of this study was to evaluate the change in ovarian reserve, ovarian volume and ovarian Doppler velocimetry after LOC, between endometrioma patients and other benign ovarian cysts.

Methods: Eighty participants were enrolled in this prospective cohort research. Aged 18-40 years suffering from unilateral ovarian cysts. Patients were classified into two equal groups: group I: unilateral (endometriotic cyst), and group II: unilateral (non-endometriotic cyst) each group was subdivided into 2 equal subgroups. Group I: subgroup A: stripping and subgroup B: cauterization. Group II: subgroup A: dermoid cysts and subgroup B: simple serous cyst.

Results: AMH (antimullerian hormone) post operation and after 3 months were significantly higher in stripping than cauterization subgroups. AMH post operation and after 3 months, AFC (unilateral antral follicle counts) after operation and reduction in AFC were significantly lower in stripping subgroup in endometrioma than dermoid subgroup in non-endometrioma. AFC before operation, reduction in AMH post 3 months, reduction in AFC and reduction in ovarian volume were significantly lower in dermoid than simple cyst subgroups in non- endometrioma group. AFC after operation was significantly higher in dermoid than simple cyst subgroups in non- endometrioma group.

Conclusions: AMH was higher in stripping subgroup than cauterization subgroup in endometrioma group post-operatively. AFC was higher in simple subgroup than dermoid subgroup in non-endometrioma group before operation, but no significant difference was noted after operation.

Open Access Review Article

Liposome Nano-particles for Therapeutic and Diagnostic Applications

Anil Kumar, K. Ravishankar, Ajit Kumar Varma, Deepak Prashar, Jaffer Sadik Mohammed, A. Mohathasim Billah

Journal of Advances in Medicine and Medical Research, Page 101-112
DOI: 10.9734/jammr/2022/v34i2031475

LNPs mix liposomes and inorganic/ organic nanoparticles. Liposomes and nanoparticles are therapeutic. LNPs are a research tool (e.g., spatiotemporal control of drug release, hyperthermia, photothermal therapy, and biological imaging). Nanoparticles determine LNP characteristics. Nanoparticles enable liposomes overcome weak stability, few functions, and fast blood elimination. Structure, physicochemical properties, modification, and biological uses of nanoparticle materials and LNPs are reviewed.

Open Access Review Article

Pathogenesis of Periodontitis: An Overview

Wael Khalil, Georges Aoun, Marwa Jaffal, Maryse Nassif, Mazen Kurban

Journal of Advances in Medicine and Medical Research, Page 113-122
DOI: 10.9734/jammr/2022/v34i2031476

Periodontitis is the severe inflammation of the tissues surrounding and supporting the tooth like gingiva, alveolar bone, and periodontal ligament. Many studies have tried to explain the pathogenesis of periodontitis focusing in many parameters such as the roles of the host pathways, the molecular and genetic factors, the bacterial biofilm mass, and the patient’s susceptibility.

The main objective of this article is to review the most relevant and comprehensive models of the pathophysiology of periodontitis and emphasize factors including the presence of systemic conditions and genetic that play a crucial role in the pathogenesis of chronic and aggressive periodontitis.

Open Access Review Article

Association between Prenatal Viral Infections and the Occurrence of Schizophrenia in Adulthood

Ioanna Kotsiri, Alexandros Spyrantis, Charalampos Panotopoulos, Emmanouil Magiorkinis

Journal of Advances in Medicine and Medical Research, Page 151-164
DOI: 10.9734/jammr/2022/v34i2031480

Schizophrenia is a severe mental disorder that affects approximately 1% of the population worldwide. Genetics and environmental factors appear to contribute to the pathogenesis of schizophrenia. Epidemiological studies have focused on the relationship between viral infection during pregnancy and an increased risk of developing schizophrenia in offspring. The aim of our review is to summarize whether viral infections during pregnancy can lead to psychiatric disorders and especially to schizophrenia in adulthood. For that purpose we undertaken a thorough search in Pubmed using as keywords viral infections, schizophrenia, perinatal infections and virus. Epidemiological studies have focused on the relationship between perinatal viral infections and an increased risk of developing schizophrenia in offspring. Influenza virus, various members of the Herpesviridae family, retroviruses, borna virus are discussed as examples of viral infections associated with schizophrenia. These viral infections appear to interfere with the normal maturation of the brain and may lead to the subsequent onset of schizophrenia. Another epidemiological aspect of schizophrenia is the fact that it presents a seasonal prevalence with peaks in offsprings which wer born during winter and spring. It is also possible for an infection occurring in infancy to reactivate later, as is known to happen with herpes viruses. Overall,various studies showed that prenatal maternal infections appear to increase the risk of developing schizophrenia in the offspring, and this is due to the body's immune response to the infection, and not in exposure to specific viral or bacterial pathogens.

Open Access Review Article

Visibility of the Mandibular Canal: From Two-Dimensional Radiography to Three-Dimensional Imaging

Wissam Sharrouf, Georges Aoun

Journal of Advances in Medicine and Medical Research, Page 427-431
DOI: 10.9734/jammr/2022/v34i2031512

The mandibular canal (MC), located within the mandible, carries the inferior alveolar nerve and the inferior alveolar vessels. This neurovascular bundle is at risk during mandibular surgical procedures. Therefore, an adequate preoperative evaluation of the MC could lead to safer treatment with fewer postoperative complications. The purpose of this paper was to review the most commonly used radiographic techniques in dentistry (periapical, panoramic, and cone-beam computed tomography (CBCT)) as well as their benefits and drawbacks in terms of MC visibility and, as a result, better preoperative planning in dentistry. Although panoramic radiography and CBCT technology are useful for the MC assessment, CBCT exposes the MC image more accurately and is thus regarded as the best technique for pre-surgery radiographic planning.

Open Access Review Article

Psammomatoid and Trabecular Juvenile Ossifying Fibromas of the Jaws: Two Aggressive Tumors

Georges Aoun, Wissam Sharrouf

Journal of Advances in Medicine and Medical Research, Page 456-460
DOI: 10.9734/jammr/2022/v34i2031516

Juvenile ossifying fibromas (JOFs) of the jaws are uncommon benign fibro-osseous tumors affecting children under 15 years of age. Based on histological criteria, JOFs have been classified into psammomatoid and trabecular. Their aggressiveness, added to their high tendency to recur, provokes real diagnostic and therapeutic challenges for the dental practitioner and makes postoperative follow-up over the years indispensable. The aim of this article was to review the clinical, histological, and radiological features of these lesions as well as their treatment modalities.