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Muhammad Khurram, Saima Ambreen, Muhammad A. Shafiq, Muhammad Naveed Shahzad, Faiqa Zikria, Sarah Yousaf Shah,
Journal of Advances in Medicine and Medical Research pp 103-110; https://doi.org/10.9734/jammr/2021/v33i1931084

Abstract:
Langerhans cell is a rare disease affecting the lungs which has a 10 years survival chance having a prognosis of 85%. It is often linked with smoking. We discuss here the correct stepwise approach towards its diagnosis Presenting a 28-year-old male smoker with a history of shortness of breath for 2 months which worsened progressively. His chest X-ray showed spontaneous pneumothorax with greater severity towards the right side. HRCT revealed multiple innumerable well-defined cystic lesions of variable sizes in bilateral lung fields, more prominent in upper lobes. A negative suction Pleur-evac was advised but the patient refused it and eventually pleurodesis using bleomycin was done to prevent pneumothorax in the future. Pleurodesis can improve the symptoms of 88 percent of patients without causing any significant complications. Although pleurodesis does not have any effect on patients' survival, it has a positive impact on their lives continuously by enhancing the quality of life.
Ndu I. K., Asinobi I. N., Nduagubam O. C.
Journal of Advances in Medicine and Medical Research pp 86-92; https://doi.org/10.9734/jammr/2021/v33i1931082

Abstract:
Aims: This study aimed to compare the difference in admission rates and severity of illness in 2019 and during the peak time period of the global SARS-CoV-2 pandemic of 2020 in children presenting at the Children’s emergency room (CHER) of Enugu State University Teaching Hospital, Enugu. Study Design: This was a cross-sectional study. Place and Duration of Study: Children’s emergency room (CHER) of Enugu State University Teaching Hospital, Enugu, from June 1 to August 31, 2019 and 2020 were reviewed, respectively. Methodology: The admission records of all the children that were admitted into CHER of Enugu State University Teaching Hospital (ESUTH), Enugu, over a three-month period from June 1 to August 31, 2019 and 2020 respectively were reviewed. Results: A total of 310 and 184 patients were seen during the study period for 2019 and 2020, respectively (40.6% decrease). A significant number of patients spent two days on admission in the children’s emergency room in 2020 than in 2019 (P < .001). Emergency admissions were 3 times more in year 2020 than in year 2019 (OR = 2.624, 95% C.I = 1.797 – 3.833, P < .001). Conclusion: Although this study reported decreased emergency room admissions, there was an increase in the mortality rate and emergency presentations.
, Ahmed M. El Khyat, Adel E. El Gergawy, Hesham A. Salem
Journal of Advances in Medicine and Medical Research pp 71-85; https://doi.org/10.9734/jammr/2021/v33i1931081

Abstract:
Background: The effect of endometriomas itself on the ovarian responsiveness that relate to ovarian reserve had been reported with several inconsistent results. In one study evaluated women with unilateral endometriomas, ovaries with disease showed lower response to ovarian stimulation than contralateral healthy ovaries .However, recent study on infertile women with un-operated unilateral small endometriomas did not support difference in ovarian responsiveness. The aim was to evaluate the impact of presence of endometriomas on ovarian reserve as measured by circulating AMH. Methods: This retrospective study was carried out on 80 female patients in childbearing period attending outpatient clinic and/or inpatient department of obstetrics and gynecology at Tanat University Hospital and the study was conducted directly after approval in the period from Apri, 2019 till April 2020. Group (A): Study group: 60 female patients aged between 20 to 30 years old GROUP (B): Control group: 20 age matched female with healthy ovaries. Results: there is no statistical significant difference between groups as regard Menarche (years), Regularity and Amount of menstrual blood flow. There is statistical significant difference between groups as regard fixed tender Right Ventricular Failure. But there are no statistical significant differences between groups as regard nodule in rectovaginal septum, fixed tender adnexal masses, association with adenomyosis and infertility. There is highly statistical significant difference between case and control groups as regard AMH levels. there are highly statistical significant positive correlation between duration of endometriosis and each of presence of pelvic pain, cyst diameter and Visual Analogue Scale. Conclusions: Women with endometrioma have significantly lower serum AMH levels and seem to experience a more rapid decline in serum AMH levels than age matched counterparts, suggesting a harmful effect of endometrioma per se on ovarian reserve.
, Ali Mahmoud Emran, Elhafez Abd Elgafez Megahed, Mamdouh Fouad Lashin
Journal of Advances in Medicine and Medical Research pp 64-70; https://doi.org/10.9734/jammr/2021/v33i1931080

Abstract:
Background: Ulnar-sided wrist pain is a common cause of upper- extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Carful clinical examination should be done, there are some provocative tests for some pathologies which induce pain when the patient has the specific pathology for the test. MRI of the wrist is often challenging because the components of the wrist have complex anatomy of bone and soft tissues, with ligaments and cartilage which are small sized structures measuring millimeters. MRI is a one of advanced imaging techniques that play an important role in evaluating the wrist and is a useful examination modality because of its multiplanar, multisequence capability and its excellent resolution of soft tissue structures. MRI is particularly advantageous for assessing occult bone lesions and soft tissue structures around the wrist such as cartilages, tendons, ligaments and nerves. Aim: The aim of this study is to assess the role and accuracy of clinical tests and MRI in diagnosis of chronic ulnar-sided wrist pain causes. Patients and Methods: This is a prospective study and was conducted on a 50 adult patients complaining from chronic ulnar side wrist pain. They were attended to Orthopedic Department of Tanta University Hospitals over a period of 6 months starting from November 2019 till May 2020. Results: MRI gave positive finding in most of patients (92%), while negative in about (8%) of cases, this means that there are some pathologies need more investigations to be diagnosed. Most of Clinical tests also gave a help in diagnosis of the cause of the pain especially ulnocarpal stress test, fovea sign test, ECU synergy test and piano key test which by statistics showed significant results but LT ballottement test had insignificant results so LTL pathology can't be diagnosed by clinical tests only but needs more investigations as MRI. So some pathologies can be diagnosed clinically as ECU tenosynovitis, but other pathologies need more investigations like MRI like LTL tear, also some pathologies need more investigations. Conclusion: Most of clinical tests give significant results in diagnosis of chronic ulnar-sided wrist pain except for some pathologies like LTL tear needs more investigations, also MRI has important role and gives significant results in diagnosis.
Zainedeen Nassar, Mazen Alzaharna
Journal of Advances in Medicine and Medical Research pp 55-63; https://doi.org/10.9734/jammr/2021/v33i1931079

Abstract:
Aims: To assess vitamin D status among Gestational Diabetes Mellitus pregnant women in Gaza Strip. Study Design: Case control study. Place and Duration of Study: Samples were collected from pregnant women attending primary health care centers, Gaza, Gaza Strip. Methodology: The study comprised 90 participants, 45 GDM pregnant women and 45 apparently healthy pregnant women. Serum vitamin D and insulin levels were measured by ELISA, fasting blood glucose (FBG), 2 h oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), triglycerides (TG), cholesterol, high-density lipoprotein (HDL), phosphorus and calcium were determined chemically. Blood pressure was measured. Body mass index (BMI) and low-density lipoprotein (LDL) were calculated. Ethical approval was acquired from Helsinki committee. All data was analyzed using the SPSS program. Results: The average vitamin D in GDM cases was lower than that in controls (P=0.031). There was an increase in the average of FBG, OGTT, HbA1c and insulin levels in GDM cases versus controls (P<0.001). The average levels of serum cholesterol, TG and LDL were significantly higher in cases as compared to controls. The average systolic and diastolic blood pressure levels were higher in GDM cases in relation to controls. Pearson correlation test showed a significant negative correlation between vitamin D and the parameters: BMI, glucose, OGTT, HbA1c and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Conclusion: Vitamin D was lower in GDM women compared to controls. Low vitamin D status may be associated with insulin resistance and act as a risk factor for GDM.
Bieye Renner Briggs,
Journal of Advances in Medicine and Medical Research pp 47-54; https://doi.org/10.9734/jammr/2021/v33i1931078

Abstract:
Banks play key roles in the economies of the world. The bank industry determines the growth of economies in all countries, as a result, workers in this industry are subjected to conditions geared towards getting the highest degree of performance from them consistently. Most of their time is spent sitting down, using computers, assuming bent postures, doing repetitive work, and sometimes without enough breaks in-between hours can predispose them to occupational hazards. This study aims to determine the prevalence of chronic low back pain among bank workers in Port Harcourt Metropolis through its associated risk factors. The study design was descriptive cross-sectional. The sample (N=332) consisted of 332 employees from twelve banks. A self-administered, closed-ended, structured questionnaire was used to collect data, and a Chi-square test (p=0.05) and odds ratio with a corresponding 95 % confidence interval was obtained. Results: Showed significant relationship between age and chronic low back pain [OR=2.87; 95 % CI=1.75 – 4.72; p=0.001], length of time in seated position had significant relationship between workers that sat for six hours and above and chronic LBP (OR=1.89; p=0.01; 95 % CI: 1.16-3.06). Also, respondents who do not sit in a comfortable seat at the office were 2.60 times more at odds of experiencing chronic low back pain compared to respondents whose seats are comfortable (OR=2.60; p=0.001; 95% CI: 1.51-4.45). Conclusion: This study shows that the risk factors of a long hour of sitting, uncomfortable chair, bent posture leads to chronic low back pain over time. Therefore, it is recommended that proper break time be observed, right ergonomics to prevent twisting the back.
, Ayman Abdelaziz El-Dorf, Shahinaz Hamdy Elshourbagy, Manal Mostafa Abdullah
Journal of Advances in Medicine and Medical Research pp 31-39; https://doi.org/10.9734/jammr/2021/v33i1931076

Abstract:
Background: Clomiphene citrate (CC) is still the traditional therapy used for inducing ovulation in polycystic ovary syndrome (PCOS). Clomiphene resistance, which refers to persistence of anovulation after standard CC therapy, occurs in 15%–20% of patients. We aimed to compare between extended letrozole versus recombinant FSH in ovulation induction in cases of clomiphene resistant polycystic ovary Methods: Seventy women with PCOS were included then patients were equally randomized to receive one of the two drugs to be given over the next 3 months. In current study Group A: letrozole group 2.5 mg two tablets once daily for 10 days from day 2 of menses. Group B: Recombinant FSH 75 i.u s.c daily from day 2 for 5 days then monitoring dose according to folliculometry. Results: There was non-significant difference between two groups as regard FSH and LH but as regard Serum E2 (pg/mL) at day 5 of HCG administration there was significant higher in FSH recombinant group. There was insignificant difference between two groups as regard Ovulating, Number of follicles >18. There was insignificant difference between two groups as regard Size of dominant follicle, endometrial thickness at hCG (mm). OHSS, discontinuation due to OHSS, clinical pregnancy, multiple pregnancy and abortion was higher in FSH recombinant group but differences didn’t reach significance. Conclusions: There was non-significant difference between two groups in relation to ovulation, Number of follicles, Size of dominant follicle, Endometrial thickness at day of HCG injection however it was reported that OHSS, discontinuation due to OHSS, positive pregnancy test, was higher in FSH recombinant group but differences didn’t reach significance level.
Mohammad Amin Aslani, Fateme Mirzaee, Amin Karimi, Amir Farahanchi Baradaran, Zohreh Zafarani, Hamidreza Aslani
Journal of Advances in Medicine and Medical Research pp 40-46; https://doi.org/10.9734/jammr/2021/v33i1931077

Abstract:
Aims: Infection is one of the most serious complications of joint replacement surgeries. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) serum levels are widely used for the evaluation of acute infections after joint replacement surgeries. The aim of our study is to determine normal changes in these inflammatory mediators after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methodology: In our study, we enrolled 100 patients with mean age of 68 y/o (57–77) and the diagnosis of primary osteoarthritis who underwent joint replacement surgery. ESR and CRP serum levels were measured before surgery, as well as one, three, and five days after surgery and then again 14, 42, and 90 days after surgery. The results were compared in two groups of TKA and THA, and patients who had undergone THA were further divided into cemented and uncemented groups. Results: The CRP serum level increased rapidly and reached its maximum level (130.47) on the third day after surgery and returned to its pre-surgery level at the end of three months in all patients. The ESR serum level reached its peak (142.65) on the fifth day after surgery and then decreased; however, it was still slightly higher than the pre-surgery levels at the end of three months. CRP showed faster and more remarkable level changes following surgery compared to ESR, and this elevation was unrelated to the pre-surgery levels. No significant difference was observed between the cemented and uncemented groups. Conclusion: Changes in CRP and ESR levels after TKA and THA surgeries are reliable indicators for assessment of prosthetic infections. In cases with an elevated CRP serum level on the third day of surgery, a strong suspicion of infection seems completely rational.
Seong Shin Kim, , Seok Kyeong Oh, Jae Hak Lee
Journal of Advances in Medicine and Medical Research pp 26-30; https://doi.org/10.9734/jammr/2021/v33i1931075

Abstract:
Patients with multiple drug allergies (MDA) can be in danger during anesthesia due to their possibility of anaphylaxis. Perioperative anaphylaxis can occur more frequently in patients with any kind of allergic history. The physiological changes during pregnancy, the existence of the fetus itself, and consequent restrictions on drug use including anesthetics make anesthetic management for pregnant women with MDA more difficult than that for other patients. Appropriate anesthetic strategy based on detailed history taking, allergological evaluations and cooperation between surgeon and anesthesiologist are essential to performing successful anesthesia. To the best of our knowledge, although there have been some cases about anesthetic management in patients with MDA, there is no reported case about surgical anesthesia for Cesarean section in a pregnant woman with MDA. Here, we present a pregnant woman with MDA who showed a positive response to most of anesthetics and analgesics in the intradermal skin test, successfully managed with an anesthetic strategy using volatile induction and maintenance anesthesia (VIMA) for Cesarean section.
, Yasser M. Hafez, Maaly M. Mabrouk, Medhat A. Ghazy
Journal of Advances in Medicine and Medical Research pp 15-25; https://doi.org/10.9734/jammr/2021/v33i1931074

Abstract:
Background: Interleukin-19 (IL-19) is a newly discovered cytokine belonging to the Interleukin-10 (IL-10) family. IL-19 has indispensable functions in many inflammatory processes and also can induce the angiogenic potential of endothelial cells. The purpose of present study was to assess the level of serum interleukin-19 (IL-19) in patients with diabetic nephropathy (DN). Our Study Aimed to assess the level of serum IL-19 in patients with diabetic nephropathy. Methods: In this cross-sectional study, we tested 90 subjects; 30 healthy control and 60 diabetic nephropathy patients recruited from outpatient clinics and wards of Internal Medicine department, Tanta university hospitals, Egypt. Patients were subdivided into 3subgroup according to the urinary albumin creatinine ratio (ACR). Results: The serum IL-19 levels in DN patients were significantly higher than the control group. The mean serum IL-19 level was 15.45±4.34 Pg/ml, 32.66±8.05 Pg/ml, 56.03±7.89 Pg/ml and 71.41±12.37 Pg/ml dL for control, normoalbuminuria group, microalbuminuria group and macroalbuminuria group respectively. Conclusions: Serum IL-19 level was significantly elevated in patients with diabetic nephropathy and was associated with the marker of inflammation CRP (C -reactive protein). So
, Cedric Sima Obiang, Hilaire Kenguele Moundounga, Elvis Othogo N’Nang, Bourdettes Meye, Iris Kévin Ivala Zogo Mba, Arnaud Brice Pambo -Pambo, Landry Eric Mombo, Cyrille Bisseye, Joseph Privat Ondo, et al.
Journal of Advances in Medicine and Medical Research pp 1-14; https://doi.org/10.9734/jammr/2021/v33i1931073

Abstract:
Objective: To evaluate the different non-surgical predominant pathologies in the emergency department of the Amissa Bongo regional hospital in Franceville, Haut-Ogooué. Materials and Methods: Using consultation registers and some medical records, we retrospectively studied the epidemiological and clinical profile of patients who consulted for a medical and non-surgical or gynaeco-obstetrical emergency, from 1 January 2018 to 31 December 2018. Results: During this period, 19597 patients consulted for a medical emergency at the Amissa Bongo regional hospital in Franceville in Haut-Ogooué (Gabon). This high score indicated that the majority of patients came from the different districts of the commune of Franceville and other departments of the province. Three periods of high attendance were distinguished: the long dry season (37.3%), the short rainy season (28.4%) and the long rainy season (24%), compared to the short dry season (10.3%). Infectious diseases were recurrent with 63.16%, and with 67% of cases, malaria (severe and simple) was more frequent. Non-infectious emergencies were also noted, such as diseases of the respiratory system (1791 cases = 24.81%), diseases of the digestive system (1028 cases = 14.24%), skin diseases (809 cases = 24.81%), cardiovascular diseases (800 cases = 11.21%), blood diseases (686 cases = 9. 5%), diseases of the urogenital system (588 cases = 8.14%), diseases of the locomotor system (510 cases = 7.06%), ENT diseases (451 cases = 6.24%), diseases of the glands and metabolism (296 cases = 4.10%), diseases of the nervous system and the senses (260 cases = 3.60%) Conclusion: Compared to non-infectious diseases, infectious and parasitic diseases are recurrent at CHRAB. They therefore require special attention from the health authorities of this hospital, and even of Gabon.
, Sekele Marob Ndjock Patrick, Ramazani Haruna, Kalala Kazadi, Sekele Isourady Bourley Jean Paul, Mantshumba Milolo Augustin
Journal of Advances in Medicine and Medical Research pp 196-207; https://doi.org/10.9734/jammr/2021/v33i1831072

Abstract:
Aims: The present study aimed to estimate the occurrence of oral sex to prevent HPV-associated or opharyngeal cancer. Study design: A prospective cohort study was conducted among the students in the Institut de Technique Medical de Kinshasa (ISTM-KIN), Democratic Republic of Congo (DRC). Place and Duration of Study: Participants were enrolled from March 2019 through April of the same year in the Democratic Republic of Congo (DRC), Kinshasa City. Methodology: Eligibility criteria included both men and women aged 15 to 45 years, enrolled in an educational program, and accepted voluntarily to respondent the survey. Demographic data, history of sexual behavior, initiation times, and knowledge about risk factors of oropharyngeal cancer were evaluated. Differences between groups of sexual behavior were tested by chi-square tests and ANOVA test at significant level of 5%. Results: Out of 1,196 participants, 412 (34.4%) were males and 784 (65.6%) females with an average (±SD) age of 20±2.4 years. A total of 964 respondents reported a history of sexually behavior (81%), of that, 53.1% had performed oral sex, 35.4% had vaginal sex and11.5% had practiced sodomy. Oral sex was the first sexual activity practiced with a significant difference among sexual behavior (P= .003). The respondents knew that oral sex is a risk factor for OPC (51.5%; n=616). Conclusion: Oral sex is the first sexual activity performed by students of Kinshasa Nursing School. Therefore, the education program to avoid the risk of HPV-associated oropharyngeal cancers may be necessary.
M. Boughdir, S. Nechi, , W. Maamatou, L. Jarray, Y. Hellal, M. A. Sebai
Journal of Advances in Medicine and Medical Research pp 188-195; https://doi.org/10.9734/jammr/2021/v33i1831070

Abstract:
Introduction: Tumors of the spleen are rare in children, but they present a wide range of diagnostic, histological and radiological appearance. Splenic cysts are far more common than solid lesions. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). They are most often asymptomatic. Diagnosis can usually be established with the clinical context and radiology (ultrasound, CT, MRI). Different options for the management of splenic cysts are available to the pediatric surgeon, ranging from simple monitoring to surgical excision. Minimally invasive surgical techniques and spleen conservative surgery have made splenic surgery less aggressive. The aim of the study was to describe the clinical and paraclinical characteristics of splenic cysts in children, and to assess their management. Patients and Methods: In a retrospective study within the pediatric surgery department in tunis, Tunisia, we have collected five children with a diagnosis of splenic cyst during the last decade. We specified for each patient the functional signs and physical examination data, ultrasound and CT were done for the patients, specifying the location and the size of the cysts. Hydatic serology was done when the parasitological origin was suggested. After surgical management and histological confirmation, the follow–up was based on clinical examination and abdominal ultrasound. Results: They were three girls and two boys. The average age is ten and a half years. All patients were symptomatic with abdominal pain. The size of the cysts was significantly increased in all patients with an average of 11 cm. Surgery was indicated for all cases. Three patients had cystic resection and two had partial splenectomy. The histology objectified epithelial cyst for three patients and hydatid cyst of the spleen for the other two cases. The subsequent outcome was favorable for all patients with a current mean follow-up of three years. Conclusion: Splenic cysts are rare in children and their management is still controversial. In splenic cysts, imaging can give clues to the diagnosis, but it often requires pathological examination of the part. Resection should be as limited as possible in order to avoid the risk of total splenectomy.
Serra Sezgin, Mehmet Can Uğur
Journal of Advances in Medicine and Medical Research pp 208-214; https://doi.org/10.9734/jammr/2021/v33i1831071

Abstract:
In rare diseases like haemophilia, access to information and experience as well as social and psychological support from social and scientific environments, especially from one’s peers and family, is important as the treatment itself. The development of social networks with the advance of communication technologies may provide health benefits for establishing and strengthening a support system. Focusing on communication and interaction in haemophilia-centred Facebook communities in Turkey, this study aims to analyse the roles and functions of such online communities in sharing and mitigating the health problems of haemophilic individuals and offering them social and psychological support. Accordingly, out of the 25 Facebook communities with Turkish content, all 10 active and open-access communities were included in the research sample and analysed through discourse analysis. The research discloses that there are discursive and functional differences in online communities established by individuals and institutions. Whereas the pages managed by organizations include more informative content with little interaction, the individual pages play a more affective role in the daily lives of haemophilic individuals, resulting in a strong network of solidarity. Therefore, the discourse on online communities were classified into two main categories, namely information exchange and emotional support. The current research on Turkey reveals the role of online communities in haemophilic individuals’ access to information on haemophilia and its treatment as well as social and psychological support. Moreover, the current research also provides room for discussion on how these online communities can better contribute to solidarity between haemophilic individuals, families, and health professionals.
, Tarek El-Sayed Amin, Dareen Abd El-Aziz Mohammed, Yomna Mazid El-Hamd Neinaa
Journal of Advances in Medicine and Medical Research pp 181-187; https://doi.org/10.9734/jammr/2021/v33i1831069

Abstract:
Background: Psoriasis is a common inflammatory skin disorder. The typical cutaneous lesions are papules and plaques covered with silvery scales distributed mainly on extensor aspects of extremities. The course and progression of the disease are unpredictable and vary in each patient. YKL-40 is a new inflammatory biomarker which may be involved the pathogenesis of the disease. Objective: The aim of this study was to study YKL-40 expression in patients with psoriasis to evaluate its possible role in the pathogenesis of psoriasis. Patients and Methods: This study included 30 patients with chronic plaque psoriasis and 10 healthy individuals of matched age and sex served as a control group. Punch biopsies of four mm were taken from the skin of psoriatic patients as well as from corresponding sites of control subjects. All specimens were examined by both hematoxylin and eosin stain and anti-YKL-40 stain. Results: The intensity of YKL-40 expression was upregulated in both epidermis and dermis of psoriatic skin in comparison with normal skin of control subjects. YKL-40 expression in psoriatic skin showed significant positive correlation with Psoriasis Area and Severity Index (PASI) score. Conclusion: YKL-40 involved in the pathogenesis of psoriasis manifested by its up-regulation in skin of psoriatic patients group in comparison to control group.
Ahmed M. Badway, Hassan A. Hassan, Mohamed F. Motwaly, Ahmed M. Ismail
Journal of Advances in Medicine and Medical Research pp 153-158; https://doi.org/10.9734/jammr/2021/v33i1831065

Abstract:
Aim: The aim of this study is to assess complications in inadvertent arterial injection and their management. Methods: From June 2018 to May 2020 in Tanta University Hospitals vascular and endovascular surgery department, this study was conducted on 30 patients with inadvertent intra-arterial drug injection complications, including femoral artery pseudoaneurysm, acute ischemia, and compartment syndrome. In 20 patients with femoral artery pseudoaneurysm, proximal control to external iliac artery and assessment of the vascularity was done intra-operatively for distal arterial Doppler flow. If the distal arterial flow was present, ligation of the common femoral artery was done, While if it was absent, iliofemoral bypass was done. Brachio-ulnar bypass was done for brachial artery pseudoaneurysm. Fasciotomy was done for compartment syndrome. Results: The mean age of patients was 27.4 years ranged from 1 year to 64 years. The femoral artery was affected in 20 cases. The brachial artery was involved in 6 cases, radial artery in 2 cases, and ulnar artery in 2 cases. In 20 patients, ligations of the common femoral artery CFA with debridement of necrotic were done for all cases. Twelve patients had good Doppler flow, eight patients had no Doppler flow, and iliofemoral bypass was done. In the upper limb cases, one case presented by severe edema in hand necessitating fasciotomy. Four cases presented with fixed color changes and gangrene in fingers after one brachial, one radial, and two ulnar arteries injections and required minor amputation. Two cases were presented with neglected ischemia and extensive infection, and above the elbow, amputation was done. In three cases with brachial pseudoaneurysm, we ligated the brachial artery, and no bypass was done with the preserved distal flow in one case; in the other two cases of brachial artery pseudoaneurysm, we did brachio-ulnar bypass. Conclusion: Inadvertent IA injection of medications has no appropriate therapeutic guidelines. The actual incidence rates, natural history, and pathophysiologic factors surrounding these complications are unclear. For prevention, the best tools are the assessment of the risk factors and consequences. The treatment options are immediate recognition of the situation, disease progress, pain control, anticoagulation, specific therapy.
Morgan Ikponmwosa, Ferguson Ayemere Ehimen, Iboro Samuel Akpan, Adioha Kelechi Chinemerem, Eze Pedro Nnanna
Journal of Advances in Medicine and Medical Research pp 159-164; https://doi.org/10.9734/jammr/2021/v33i1831066

Abstract:
Pyogenic spondylitis involves a broad spectrum of structures around the spine including the vertebra (vertebral osteomyelitis), discs (septic discitis) and epidural abscess. Symptoms may include fever, pain, sensory-motor deficits, and obtundation. Fever is a symptom, however, may not be common as it occurs in less than of patients. It may affect any aspect of the spine, with the cervical spine been the least affected. Magnetic resonance imaging (MRI) is critical for early diagnosis and extensively used for diagnosis. Our case presents a lady who was referred for an MRI of the neck following neck pain for over 3 months.
Journal of Advances in Medicine and Medical Research pp 176-180; https://doi.org/10.9734/jammr/2021/v33i1831068

Abstract:
The vermiform appendix has varied locations ranging from retrocaecal, pelvic, paracolic to pre-ileal and postileal. Inguinal appendix or Amyand’s hernia is an extremely rare occurrence with potentially fatal complications. Rarer still is the presence of an inflamed appendix in the inguinal canal in the elderly. Due to its rarity, the pathophysiology and risk factors of the condition are still unclear. Some theorize that it is secondary to a patent processus vaginalis or perhaps the presence of a fibrous band between the hernia sac and testes. Reported herein is a 64-year-old man who presented with a painful irreducible right inguinal swelling. An incarcerated inguinal hernia with the hernia sac harbouring an inflamed vermiform appendix was discovered at surgery. Appendectomy and a primary suture repair of the hernia were carried out. The postoperative period was uneventful. Surgical management of inflamed inguinal appendix carries a risk of septic complications. It is pertinent that every surgeon performing a hernia repair must be aware of this condition and the appropriate treatment modalities.
D. A. Hassan, M. I. Elamin, H. M. Beheiry, A. A. Abdalla, N. A. Fahal, S. A. Medani, A. B. Musa, I. A. Ali
Journal of Advances in Medicine and Medical Research pp 165-175; https://doi.org/10.9734/jammr/2021/v33i1831067

Abstract:
Aims: To investigate the effect of elevated resting heart rate (RHR), hypertension (HTN) and associated risk factors on the prevalence of stroke among Sudanese adults. Study Design: This is a cross-sectional study based on a survey conducted by Sudanese society of hypertension during the May Month of Measurement (MMM), 2018 campaign. Methods: A total of 12281 respondents (mean age: 32.5±14.5 years, 49% men) were included. Structured questionnaires of demographic data, and self-reported medical history were filled by all respondents and analyzed. Blood pressure and RHR were measured using an Omron BP monitor. Participants were divided into two main cohorts: normotensive (n=9497, 77.3%) and hypertensive (n=2784, 22.7%) participants. Each cohort was then segregated into three sub-cohorts using RHR tertiles (T1: 100 bpm). Results: Multivariate logistic regression analyses were performed to assess the individual and combined effect of RHR and HTN on prevalence of stroke. Hypertensive patients were more likely to develop stroke compared to normotensive participants (OR= 2. 968, 95% CI 2.028-4.345). Within the hypertensive cohort, RHR T3 participants had a significantly increased risk of stroke compared to RHR T1-T2 combined (OR= 2.35, 95% CI1.043-5.323). Individuals of RHR T3 sub-cohort were more likely to be younger, leaner and displayed significantly higher level of both systolic & diastolic blood pressure compared to RHR T1 and T2 groups. Diabetes Mellitus and smoking increased the odds of stroke among both normotensives (OR (95% CI):5.6 (2.24- 14.09), 3.17 (1.71-6.08 respectively), and hypertensives (OR (95% CI): 4.40 (2.26-8.58), 2.03 (0.95-4.32) respectively). Female gender and older age also increases the odds of stroke among hypertensives (OR (95% CI): 1.85 (1.00- 3.45) and 2.00 (1.02- 4.17) respectively. In conclusion, this study demonstrated that HTN was an independent risk factor of stroke. The effect of elevated RHR on stroke was only prominent when joined to high blood pressure. Prevalence of tachycardia was higher among the young participants which make them more prone to stroke if the condition is associated with HTN. Our results highlight the importance of addressing elevated RHR to reduce the risk of stroke particularly among hypertensive patients.
, Niranjan Agarwal, Kushal Mital
Journal of Advances in Medicine and Medical Research pp 143-152; https://doi.org/10.9734/jammr/2021/v33i1831064

Abstract:
Background: Hemorrhoids are the most common anorectal disease. In Finger guided Hemorrhoidal Artery Ligation (FGHAL), the branches of Superior Hemorrhoidal Artery (SHA) are ligated after palpating the arteries with finger 2-3 cm above dentate line instead of using a doppler as in Doppler-guided Hemorrhoidal Artery Ligation (DGHAL). The procedure is followed by Laser Hemorrhoidoplasty (LHP), a minimally invasive technique. Methods: We conducted the study to retrospectively analyze the clinical outcomes of FGHAL with LHP for surgical management in a patient cohort with hemorrhoids in routine clinical practice. We retrospectively collected and analyzed the data from hospital records of patients treated with FGHAL with LHP for their hemorrhoid disease (HD) from March 2017– March 2020 to understand the impact on pain, bleeding, and resolution of symptoms. Results: The study included a total of 346 patients within 27 to 75 years of age. The presenting features were bleeding (93%), pain (89%), and prolapsed hemorrhoids (69%). Most patients had grade II hemorrhoids (60.7%). Patients reported no spontaneous bleeding after surgery; 225 patients (65%) experienced post-defecatory bleeding the day one after surgery and 98 patients (28.3%) on postoperative day 3. Patients did not report any bleeding after the 7th postoperative day. 90.2% had completely resolved symptoms 6-months after surgery. The average VAS score at 6h,12h,24h,48h and 72h after surgery were 3,2.2,1.3,0.4 and 0.1 respectively. Conclusion: FGHAL is a cost-effective alternative to DGHAL. FGHAL, followed by the LHP technique, provides a very low pain and discomfort with minimal need for analgesics and wound care, electing it among the procedures suitable for HD. The method is a cost-effective alternative to DGHAL.
Nada S. Abdul Aleem, Raghda A. El-Dakhakhni, Sahar M. Hazzaa, Nagwa I. Aglaan, Hesham M. Borg
Journal of Advances in Medicine and Medical Research pp 130-142; https://doi.org/10.9734/jammr/2021/v33i1831063

Abstract:
Background: The severe form of nausea and vomiting of pregnancy called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Helicobacter pylori (H. pylori) is a prevalent gram-negative flagellated spiral bacterium that colonizes the stomach of half of the world’s population. Researchers have hypothesized that maternal hormonal and immunological changes during pregnancy that prevent allogenic rejection of fetus reactivates the bacterium. Aim of the work is to compare between patients with hyperemesis gravidarum and normal pregnancy regarding presence of Helicobacter pylori antibodies for proper management. Materials and Methods: A case-control study was carried out on ninety pregnant women at 5-15 weeks of gestation, thirty pregnant females with single living fetus complaining of HG (Group A), Thirty pregnant females who were multiple pregnancy and/or trophoblastic disorders complaining of HG (Group B) and Thirty pregnant females with normal pregnancy (Group C). Serum test for H. pylori IgG antibody titer was done for all patients and controls using enzyme immunoassay-based kit. Results: H. pylori were noted in 32 hyperemetic cases and 6 control subjects. The presence of H. pylori increased the risk of HG more than two fold (OR = 2.923, 95% CI: 1.326-6.446, P < 0.05). Conclusion: There is powerful correlation between H. pylori and hyperemesis gravidarum which proved in single, multiple pregnancy and/or trophoblastic disorders.
, Doaa Waseem Nada, Arwa Mohammad Hassan, Doaa Salah Hegab
Journal of Advances in Medicine and Medical Research pp 120-129; https://doi.org/10.9734/jammr/2021/v33i1831062

Abstract:
Background: Alopecia areata (AA) is a non-scaring alopecia which can affect any body hairy area. Excimer light 308 nm is a UVB irradiation with immunosuppressive effects. Low level light therapy (LLLT) emits low energy visible and infrared irradiation to modulate biological processes in cell. This study aimed to evaluate efficacy and safety of excimer light 308 nm versus LLLT in treatment of AA. Methods: Thirty patients with multilocular AA of the scalp were collected after excluding those with alopecia totalis, universalis, AA in other body sites than scalp, those with other systemic or dermatological diseases, those received topical therapy in the last 2 weeks or systemic therapy for AA in the last three months, pregnant and lactating females. Patients were distributed into two equal groups; group A was treated by excimer lamp and group B was treated by LLLT. Sessions were repeated twice weekly for 3 months and patients were followed for 3 months. Treatment efficacy was evaluated by severity of alopecia tool score (SALT score) and Dermoscopy; at baseline, at end of sessions and at follow up. Results: A statistically significant improvement was detected in treated patches of both groups than control patches at end of sessions and only in group A at follow up. There was no statistically significant difference between both groups according to short vellus hair and regrowing hair at end of sessions and at follow up in dermoscopy. Side effects reported were minimal and transient in both groups. Conclusion: Both excimer light and LLLT are safe and effective in treatment of AA. Apart from its relatively higher cost, Excimer light induced better and more sustained improvement than LLLT.
Shahenda H. Basha, Doaa N. Shatat, Adel E. Elgergawy, Mohsen M. Elnamoury
Journal of Advances in Medicine and Medical Research pp 110-119; https://doi.org/10.9734/jammr/2021/v33i1831061

Abstract:
Background: For multifactorial reasons, the rate of cesarean deliveries increased clearly over a decade; decreased in vaginal births after cesarean (VBAC), multiple gestation, maternal obesity, pre-term labor, gestational diabetes or hypertension, increased number of high-risk expectant mothers and the obstetrical medico-legal environment. Delivering the fetal head at cesarean section can also be a lengthy operation and can result in maternal or fetal Complications. The vacuum extractor allows for the application of traction on the fetal head. In this study we aim to compare the safety (for mother and infant) and efficacy of delivery of the fetal head in cesarean section using vacuum extractor with the manual extraction. Methods: This study was conducted on 60 pregnant women undergoing cesarean section. All patients were between 37 and 42 weeks of pregnancy with signs of healthy fetus and were divided into 2 groups; Group I- 30 patients subjected to vacuum extraction at the cesarean section, Group II- 30 patients subjected to the conventional cesarean method. The result: The BMI of women in group I was 27.90 ± 0.96 and in group II was 28.0 ± 0.98. The gestational age of the babies in Group I and II were 39.0 ± 1.02 and 39.0 ± 0.98 weeks. U-D interval for Group I and Group II were 48.40 ± 17.63 and 73.87 ± 16.76 days respectively. The estimated blood loss in group I and group II were 478.0 ± 59.62 and 464.7 ± 52.57 respectively. The birth weight of the babies delivered in Group I and Group II were 4253.33 ± 118.72 and 4246.67 ± 135.58 KG respectively. The five minutes Apgar score for Group I and Group II were 8.50 ± 0.68 and 8.57 ± 0.57. Conclusion: The use of the vacuum extractor at cesarean section may be a safe and effective method to facilitate delivery of the large fetal head and cesarean section delivery can be simplified by this technique.
, Asifa Nazir, Humaira Bashir, Umara Amin
Journal of Advances in Medicine and Medical Research pp 99-109; https://doi.org/10.9734/jammr/2021/v33i1831060

Abstract:
Aims: We aimed to evaluate the burden of bacterial co-infections in patients with COVID-19 and to ensure judicious use of antibiotics. Study Design: Hospital based, cross sectional study. Place and Duration of Study: Postgraduate department of Microbiology, Government Medical College, Srinagar, and associated hospitals, between July 2020 and February 2021. Methodology: A total of 70 patients diagnosed with COVID-19 by RT PCR of nasopharyngeal/oropharyngeal samples were included in the study. Lower respiratory specimen like endotracheal aspirate (ETA), sputum, and bronchoalveolar lavage (BAL) from COVID-19 patients admitted in the ICU were collected as per standard protocol and subjected to quantitative cultures in the laboratory. Antimicrobial susceptibility testing was carried out in line with CLSI recommendations. Results: Of the 70 lower respiratory tract specimens (Endotracheal aspirate n=53, sputum n=15, and Bronchoalveolar lavage n=02) taken from RT-PCR confirmed COVID-19 patients, 51 (72.9%) showed microbiological evidence of bacterial infection by culture positivity. 28/51 (55%) were males and 23/51 (45%) were females, mean age was 54 years (range= 16-85 years). Majority of the organisms recovered (n=51, 83%) were Gram-negative bacilli, among which Acinetobacter spp. (n=27, 53%) followed by Klebsiella pneumoniae (n=06, 12%) were the most common. Among Gram positive organisms, methicillin resistant Staphylococcus aureus and Enterococcus sp were most commonly isolated. Conclusion: It is evident from our study that superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus is of serious concern. Timely treatment of these infections is pivotal to decrease the morbidity and mortality rates in COVID-19-infected patients.
, Mohamed Hosny El Bradaey, Hala Mohamed Nagy, Mohamed Ramadan El-Shanshory, Eslam Elhawary
Journal of Advances in Medicine and Medical Research pp 93-98; https://doi.org/10.9734/jammr/2021/v33i1831059

Abstract:
Background: Sickle cell disease (SCD) consists of a group of hemoglobinopathies in which individuals inherit hemoglobin variants derived from single point mutations. Asymmetric dimethylarginine (ADMA) contributes to limiting Nitric Oxide (NO) bioavailability in SCD. The aim of the present study was to assess the level of the Asymmetric Dimethyl Arginine in children with sickle cell. Methods: This cohort cross-sectional study was carried out on 60 children which were divided in to 3 equal groups. Group I: SCD children with sickle retinopathy. Group II: SCD children without retinopathy. Group III: healthy control children who were selected from the outpatient clinic. Results: There was a significant increase in ADMA level among participants withSCD. There was a positive significant correlation between ADMA level and family history as well as the incidence of hepatomegaly. There was no significant correlation between ADMA level and demographic and laboratory parameters except LDH. Conclusions: The level of ADMA is elevated in children with sickle cell anemia. High plasma ADMA level is a risk for hepatomegaly in children with sickle cell anemia.
Journal of Advances in Medicine and Medical Research pp 87-92; https://doi.org/10.9734/jammr/2021/v33i1831058

Abstract:
Introduction: Tuberculosis remains a global public health concern. Abdominal tuberculosis is an atypical presentation and since it is extrapulmonary it may delay the diagnosis and treatment of this condition. The case report describes a typical presentation of abdominal tuberculosis and highlights the difficulties which are encountered in the diagnosis of abdominal tuberculosis. Presentation of case: A 56 year old gentleman admitted to hospital with a 1 week history of generalised abdominal pain associated with abdominal distention and vomiting. The chest-X-ray was unremarkable and the abdominal X-ray revealed air-fluid levels. Laboratory investigations revealed a high white cell count at 14,000µl. At laparotomy, multiple small whitish deposits in the greater omentum and on the bowel with a frozen abdomen was found. Biopsy of these whitish deposits showed histology of giant Langhans multinucleated cells with acid-fast bacilli and necrosis and a granulomatous inflammatory process. Anti-tuberculosis treatment was initiated using a combination of antibiotics and he made an uneventful recovery. Discussion: The clinical abdominal TB presentations include acute, subacute or chronic disease. The chest-X-ray of our patient showed no evidence of pulmonary tuberculosis however this is not surprising as less than half of patients with abdominal TB have pulmonary tuberculosis. Ultrasound findings in abdominal TB include thickening of the wall of the ileum, caecum and colon and associated ascites. When malignancy cannot be ruled out with certainty then laparotomy is recommended with biopsy of any peritoneal lesions, omental lesions and a lymph node biopsy. Conclusions: Judicious use of diagnostic procedures and a high index of suspicion may help in the timely diagnosis and treatment of abdominal tuberculosis. Biopsy of peritoneal/omental lesions and of a mesneteric lymph node is advisable to distinguish abdominal tuberculosis from peritoneal carcinomatosis.
Amal Abdelaziz Abdellatif Elnomany, Hossam Abd El Mohsein Hodeib, Ghada Fouad Elbaradey, Mohammad Abdelrahman Sweilam
Journal of Advances in Medicine and Medical Research pp 81-86; https://doi.org/10.9734/jammr/2021/v33i1831057

Abstract:
Background: Sepsis is an unorganized host response to infection that is manifested by the failure of organs and DIC and systemic coagulation due to failure of Plasmin as an important fibrin lytic protein that is regulated by plasminogen activators and inhibitors. Our theory is that elevated PAI-1 may have a role in multi-system organ failure in patients with septicemia and systemic coagulopathy. Aim: to evaluate plasminogen activator inhibitor-1 as a prognostic factor in patients with septicemia and DIC. Patients and Methods: 60 cases with septicemia and in shock, in addition to 20 healthy individuals. Cases were selected from surgical ICU, Tanta University hospitals. Normal healthy subjects were matched by age and gender with the patients' group. Results: Respiratory system and urinary tract infections, were the most common infections and high SOFA and APACHE scores in the selected cases. The hematological findings in septic patients are anemia, thrombocytopenia, and leukocytosis. There was a significant increase in urea, creatinine, SGOT, SGPT levels, and CRP in patient groups. Higher levels of PAI-1 in cases suffering sepsis. An increased mortality rate after 28 days of follow-up was noticeable in cases with established septic shock compared to other patient groups in Tanta university surgical intensive care. We found a direct correlation between PAI-1and SOFA, APACHE, bilirubin, creatinine, PT, APTT, and Procalcitonin. Conclusions: PAI-1 level has a prognostic value in cases with infections or septicemia presented to our emergency center.
Judy Mwai, , Jarim Omogi, Mohamed Abdi, Diana Nyole, Lydia Kaduka, Joseph Mutai, Philip Ndemwa
Journal of Advances in Medicine and Medical Research pp 73-80; https://doi.org/10.9734/jammr/2021/v33i1831056

Abstract:
Aim: Corona Virus Disease-19 (COVID-19) pandemic led countries into engaging public health guidelines as a strategy towards preventing infections. Hand washing, social distancing and masking remains key measures for infection control and prevention of the COVID-19. Strict adherence to public health infection control and prevention protocols is necessary to contain the spread at the community stage of the virus. National and County governments in Kenya directed efforts and resources in implementing numerous infection control and prevention measures in public places and institutions. The study assessed adherence to water, sanitation and hygiene (WASH) guidelines among the residents of Kilifi and Mombasa County in combating COVID-19 infections. Methodology: A cross sectional study was conducted between 25th November and 4th December 2020 in ten sub-counties in Mombasa and Kilifi counties, Kenya. Data was collected using Open Data Kit (ODK) mobile application. Results: Forty observations were done in Kilifi (45 percent) and Mombasa (55.0 percent). More than a third (37.5 percent) of the observations were done at the household level, followed by public buildings (30.0 percent), market/shopping centers (30.0 percent) and bus terminus (2.5 percent). More than half of the occupants in both Kilifi 55.6 percent and Mombasa 68.2 percent observed physical distancing of 1.5 meters, however, low screening of temperature at the entrance was noted. The general observation shows only 55.6 percent of the premises visited had a hand-washing station in Kilifi while 68.2 percent in Mombasa County. Most of the hand washing stations had running water and people did proper handwashing in both Counties. Only 30.0 percent of the hand station at Kilifi County had soaps. Conclusion: COVID – 19 will continue to pose serious public health challenges as many premises still don’t adhere to some of the guidelines. Multi-sectoral feasible approaches towards ensuring further adherence on all the public health guidelines should be given priority to control and prevent COVID-19 infection
Mohamed G. Mohamed, Hanaa I. Okda, Hossam A. Hodeib, Mostafa T. Gabr
Journal of Advances in Medicine and Medical Research pp 64-72; https://doi.org/10.9734/jammr/2021/v33i1831055

Abstract:
Background: Vitamin D deficiency is commonly encountered in patients with chronic kidney disease (CKD) with or without undergoing dialysis. This study was conducted to assess vitamin D level in patients diagnosed with predialysis CKD stage 3 – 5, and to determine the predictors of its deficiency in such patients. Materials and Methods: This cross-sectional study included 75 patients who were divided into three equal groups of CKD-3, CKD-4 and CKD-5. All cases were subjected to detailed history taking, physical examination and measurement of estimated glomerular filtration rate (eGFR) according to Cockcroft-Gault formula. In addition, laboratory investigations included CBC, renal function tests, serum ferritin, intact parathyroid hormone (iPTH) and vitamin D level. Results: Patient demographics and other co-morbidities were comparable among the three groups. Serum vitamin D had mean values of 24.84, 20.52 and 11.24 ng/ml in patients with stages III, IV and V respectively, with significant difference between the three groups. Vitamin D deficiency was more common in CKD-5 cases. On the contrary, serum parathyroid hormone and ferritin were significantly higher levels, in patients with higher stages. There was statistically significant positive correlation of serumvitamin D with eGFR, Hb, calcium and albumin. On the other hand, serum vitamin D was negatively correlated with phosphate, PTH, urea andcreatinine. Conclusion: It is evident that higher stages of CKD are associated with more vitamin D deficiency.
, Vipin Roach, Surinder Singh
Journal of Advances in Medicine and Medical Research pp 57-63; https://doi.org/10.9734/jammr/2021/v33i1831054

Abstract:
Background: Bicytopenia and Pancytopenia are relatively common presentations in adults as compared to paediatric patients. Clinical features present in different manifestations in children with Pancytopenia/Bicytopenia, which can range from bone marrow suppression temporarily to marrow infiltration by life-threatening malignancies. Aim: To study the clinical and haematological profile in the paediatric age group withCytopenias. The study aims to analyze the severity of hematological findings as per causative factors in patients with Pancytopenia and Bicytopenia. Methods: Prospective Observational Study conducted in the Department of Paediatrics in Dr.RPGMC Tanda Himachal Pradesh (INDIA). The study included all patients except those falling in the exclusion criteria.It was performed after oral and written informed consent.A total of 50 children admitted with bicytopenia and pancytopenia were enrolled from March 2013 to March 2014. Results: Infection was the commonest etiology observed in 22(44%) patients with bicytopenia and pancytopenia. Bicytopenia was seen in 14 (20%) and pancytopenia in 8 (16%) cases with infection. Scrub typhus was the commonest Infection seen in 18(32%).Leukaemia was notedin 11(22%) cases. Conclusions: The commonest age group affected was 11-15 years with female domination with a Male: Female ratio of 0.78:1. The commonest symptom was fever 37(74%) then generalized weakness in 29 (58%) cases.Pallor was the most common sign in 43(86%) followed by Hepatomegaly 32(64%), Lymphadenopathy 30(60%), and Splenomeagly in 29 (58%) patients. Infection was the commonest etiology followed by leukemia and megaloblastic anaemia. Scrub typhus was the commonest infection encountered in the present study.
, Akshay Rahurkar, Hrudini Dixit, Chelliah Sekar
Journal of Advances in Medicine and Medical Research pp 51-56; https://doi.org/10.9734/jammr/2021/v33i1831053

Abstract:
Aims: The expanded horizon of the ultrasound-guided erector spinae plane block (ESPB) shows promising results in various surgeries involving the thoracic, abdominal, pelvic, joint, and spine regions. We aimed to administer ESPB in spine surgery of the early pediatric age group patient to reduce the overall requirement of the intraoperative general anesthetic drugs and postoperative opioids due to high analgesic demands. Presentation of Case: We report the application of ultrasound-guided bilateral ESPB as multimodal analgesia (MMA) component in the spine surgery of the youngest (2-year old) age group. Discussion: Spine surgeries, especially scoliosis surgeries, are associated with extensive surgical dissection, leading to significant postoperative nociception causing high analgesic demands and necessitating high opioid consumption. It further leads to opioid-related side effects, delay in discharge, late ambulation, and prolonged hospital stay. The ESPB potentially helps in controlling polypharmacy by providing wide multisegmented analgesic coverage due to its multidirectional drug spread pattern. There are upcoming concerns regarding anesthesia-induced developmental neurotoxicity and the detrimental effect of general anesthesia in developing children. Such concerns can be addressed by cutting down the requirement of general anesthetic agents to a minimum level with the help of modalities like MMA incorporating regional analgesia (RA) as an adjunct. Conclusion: The ESPB can be a safe and effective adjunct to the MMA in providing opioid-free optimal analgesia in spine surgery of the youngest population.
Zahraa M. Lutfy, Ayman S. Dawood, Adel E. Al Gergawy, Mustafa Z. Mustafa
Journal of Advances in Medicine and Medical Research pp 27-42; https://doi.org/10.9734/jammr/2021/v33i1831051

Abstract:
Background: The increasing prevalence of obesity worldwide has prompted the World Health Organization (WHO) to designate obesity as one of the most important global health threats. The epidemic is especially pronounced in women of reproductive age. Prepregnancy obesity is an independent risk factor for maternal and neonatal morbidity and mortality. The origin of this epidemic is unhealthy lifestyle – high energy and high-fat diet and physical inactivity. During periconceptual period and pregnancy, the composition of a woman’s diet is of particular importance, as it may influence the pregnancy, the delivery and the health of the mother and the infant later on, so an excessive gestational weight gain (GWG) is not recommended. The aim of our study is to clarify the complications related to excess prepregnancy body weight on maternal and fetal health. Methods: Hundred obese pregnant women with BMI (30-40 Kg/m2) measured at first trimester were prospectively enrolled into this study. Routine blood pressures, random blood sugar measuring and ultrasonographic follow up are required during pregnancy for early detection of any complications related to maternal obesity and excessive gestational weight gain (GWG). Results: cases statistically evaluated in these study were 100 pregnant females with mean age 27.34 years + 5 years SD and mean BMI 32.97 Kg/m2 + 2.92 Kg/m2 SD. Denoting in our study, the effect of maternal obesity om maternal and fetal health. Conclusion: A causal relationship between the prepregnancy BMI and obstetric complications is proven. Weight management is important for every women of reproductive age. Thus, medical Practice must consider these complications by providing early detection and management to improve both maternal and neonatal outcome.
, Mohamed Mohsen Elnamoury, Ayman Abd Elaziz Aldorf, Essmat Hamdy AboZeid
Journal of Advances in Medicine and Medical Research pp 43-50; https://doi.org/10.9734/jammr/2021/v33i1831052

Abstract:
Background: Changes in thymus size and histopathology have been observed both in animal models of intrauterine growth restriction (IUGR). The aim of the present study was to evaluate the size of the fetal thymus by sonography in pregnancies with IUGR and to search for a possible relationship between a fetal thymus size and adverse perinatal outcomes. Methods: This prospective observational study was carried out on 100 participants who were divided into two groups. Group A: Study group which include 50 patients with IUGR. Group B: Control group which Include 50 normal patients with appropriate gestational age. All patients were subjected to: History taking: (Personal, Obstetric History, Maternal Medical History) and trans-abdominal ultrasound. Results: IUGR group show statistically significant decrease in the estimate of fetal weight (EFW) compared to the control group (P<0.05). Doppler study of umbilical artery shows significant increase of (pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) in IUGR group when compared to control group. Doppler study of middle cerebral artery (MCA) shows significant increase in (RI, SD) in IUGR group when compared to control group while PI doesn’t show significant difference between two groups. Thymus size decrease in IUGR group when compared to the control group. IUGR group had low survival and lower APGR Score when compared to the control group. Correlation between thymus size with the studied doppler parameters and pregnancy outcome in the current study. Umbilical Doppler RI, PI and SD showed statistically significance in this study (P<0.05) and this means that the blood flow in the umbilical arterial (UA) is important for the fetus. As regard the MCA RI and SD Doppler, they show statistically significance in this study (P0.05). Conclusions: IUGR is associated with small thymus and small fetal thymus may be an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.
B. I. Omolabake, A. F. Uko
Journal of Advances in Medicine and Medical Research pp 22-26; https://doi.org/10.9734/jammr/2021/v33i1831050

Abstract:
Aims: The COVID-19 pandemic disrupted healthcare globally and several authors have observed a change in the presentation of acute appendicitis within the period. We have observed an upsurge in the presentation of complicated appendicitis within the first 4 weeks of 2021. We aim to compare our findings with a similar period prior to the COVID-19 pandemic. Study design: Observational cohort study. Place and duration of the study: Benue State University Teaching Hospital(BSUTH), Makurdi, Nigeria. Methodology: We identified all patients that presented with appendicitis in our facility within the first four weeks of 2021 and retrieved their folders to ascertain our observation. We then retrieved the folders of patients who presented with appendicitis a year earlier when the pandemic was inexistent in our country. We compared the data between the two periods. Results: In the period of the pandemic, we found an increased presentation of acute appendicitis, with most patients presenting as complicated appendicitis. There was an increased length of time between symptom onset and presentation, increase in operating time, postoperative complications, and length of hospital stay in the index period. Conclusion: We conclude that there is an apparent increase in the presentation of complicated appendicitis with a resultant increase in post-operative complications and morbidity. However, these changes are likely a result of our response to the COVID-19 pandemic rather than the pathology of the SARS CoV-2 virus. We suggest that with the relaxation of movement restrictions and lockdowns in most places, and availability of COVID-19 vaccines, public enlightenment is necessary to encourage an early presentation of acute abdominal conditions with a view to decreasing morbidity.
, Ayman S. Dawood, Ahmed T. Morsy, Hesham A. Salem
Journal of Advances in Medicine and Medical Research pp 1-12; https://doi.org/10.9734/jammr/2021/v33i1831048

Abstract:
Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in the reproductive period. It is one of the leading causes of infertility. The manifestations of PCOS include irregular or no menstrual periods, excess body weight and facial hair, acne, heavy periods and pelvic pain. The aim of this study is to determine the efficacy of stair step protocol compared to traditional protocol in ovulation induction of polycystic ovarian syndrome (PCOS) patients in terms of increasing rate of ovulation and pregnancy. Methods: This study is non-blinded, multicenter, randomized controlled study and was carried out on infertile women attending the Fertility Clinic of Tanta University Hospital and Hurghada General Hospital. Two Hundred infertile patients with PCOS criteria and no other causes of infertility were enrolled according to inclusion and exclusion criteria. Results: Student t test was used for the continuous variables (FSH, LH, Prolactin, AMH, TSH, Free testosterone). Student t test was used for the continuous variables (Endometrial thickness, Time to ovulate (d)). Chi-square analysis was used for the categorical variables (Ovulation rate, Pregnancy rate). Chi-square analysis was used for the categorical variables (Ovulation rate per cycle). There was no significant difference between two groups as regards mild and severe side effects. Conclusions: This study concluded that stair step regimen improves the ovulation rate and pregnancy rate without any detrimental side effects compared to traditional regimen. It helps to know the sensitivity and resistance of an individual to clomiphene citrate much earlier and helps to plan ahead with alternative treatment for desired outcome. The advantage of shorter treatment period with similar side effects makes the stair step protocol suitable for use in routine clinical practice.
, Adewale T. Olajide, Bola O. Ojo, Tosin O. Babalola, Oluwatoyin I. Oyekale
Journal of Advances in Medicine and Medical Research pp 13-21; https://doi.org/10.9734/jammr/2021/v33i1831049

Abstract:
Background: Carriage of methicillin-resistant Staphylococcus aureus (MRSA) among Healthcare workers (HCWs) who serves as agent of pathogen transmission in hospital settings portends danger to critical care patients. Aim: To determine the carriage rate of MRSA among HCWs in the critical care units of the hospital, to identify the factors associated with carriage, and to determine the antibiotic resistance pattern of isolates. Study Design: A cross sectional descriptive study. Materials and Methods: A total of 135 randomly selected consenting HCWs from critical care units were studied. Data on demographic characteristics and infection control practices were obtained from participants with the aid of questionnaire. Swabs of the anterior nares and hands of participants were cultured on oxacillin-containing mannitol salt agar (MSA), S. aureus was identified using convectional criteria and MRSA was identified by cefoxitin disc diffusion technique. Antibiotic susceptibility testing was carried out on all isolated MRSA. Results: Carriage rate of MRSA was high (26.7%). Poor handwashing practices (P=.008) and presence of wound or skin infection (P=.003) were associated with higher isolation rate. None of the age, gender, profession and duration of unit stay of workers was associated with carriage rate of MRSA. Isolation rate was higher from the nose (18.5%) than the hands (8.1%). Isolates demonstrated high resistance to antibiotics: penicillin (100%), amoxicillin/clavulanate (66.7%), cefuroxime (61.1%), ceftriaxone (63.9%), erythromycin (55.6%). All isolates were sensitive to vancomycin. Conclusion: Carriage rate of MRSA among critical care unit staff was high in this study. There is urgent need for formulation of infection control policies and enforcement, to prevent MRSA spread among critical care patients.
Merihan Mohamed Elewa, Ayman Abdelaziz Eldorf, Shahinaz Hamdy Elshorbagy, Manal Mostafa Abdallah
Journal of Advances in Medicine and Medical Research pp 221-231; https://doi.org/10.9734/jammr/2021/v33i1731047

Abstract:
Background: Cryopreservation's success rate varies depending on woman age, as low as 14.8% (if eggs were extracted from 40-year-old women), and as high as 31.5% with 25-year-old women. The goal of the research is to improve laboratory methods for freezing-thawing embryos, leading to elevated embryo survival rate. Yet, in hormonal replacement therapy frozen-thawed embryo transfer (HRT-FET) cycles, effective endometrial preparation before embryo transfer attracted less focus. The present research’s aim is to see whether there's a link between blood progesterone levels and pregnancy rates the day before frozen-thawed embryo transfer. Methods: This prospective observational research has investigated 120 patients of frozen-thawed embryo transfer cycle treatment, only 100 individuals subdivided to 2 groups for serum level of progesterone one day before frozen-thawed embryo transfer. The subjects visited both the Obstetrical and Gynecological Department of Tanta University as well as private centers between May 2020 and January 2021. Results: We discovered no correlation between maternal age with pregnancy test results. Yet, our study discovered highly significant variation among both groups regarding endometrial thickness one day preceding embryo transfer, and regarding pregnancy rate (p<0.05). Conclusion: The serum progesterone hormone preceding frozen embryo transfer has significant and direct relation and impact upon pregnancy rates. The present research detected low serum progesterone less than 10 nanograms/ml in the day before frozen-thawed embryo transfer in HRT-FET cycles significantly decreased probability of ongoing pregnancy post frozen-thawed embryo transfer.
Mishio Bawa Elijah, Mensah-Onumah Deborah, Julius Tieroyaare Dongdem,
Journal of Advances in Medicine and Medical Research pp 202-213; https://doi.org/10.9734/jammr/2021/v33i1731045

Abstract:
Aim: To determine the prevalence, awareness and risk factors associated with hypertension among adults. Study Design: Cross-sectional study. Place and Duration of Study: Tamale Metropolis from January to March 2020. Methodology: 200 adults (101 men and 99 females) aged 40 years and above were recruited. Socio-demographic characteristics, anthropometric and blood pressure data of participants collected through face-to-face administered questionnaire and physical measurements were analyzed for prevalence, knowledge and awareness of hypertension. Binary and multivariate logistic regression was used to estimate the odds of association of risk factors with hypertension. Results: Overall age-standardized prevalence of hypertension was 46.00% (49.50% in males, 42.42% in females). The prevalence of both systolic and diastolic hypertension was higher in males than in females. 49.10% of hypertensive participants were unaware of their status at the time of this study and 83.3% of the hypertensive participants who were aware of their status were diagnosed incidentally. Multivariate logistic regression analysis revealed a significant positive association of being male [AOR = 2.39, (95% CI: 1.08–5.30)], aged between 50 – 65 years [AOR = 2.03, (95% CI: 1.03–4.01)], and being obese [AOR = 3.64, (95% CI: 1.43–9.29)] with hypertension. Being widowed [AOR = 0.06, (95% CI: 0.01–0.66)] was negatively associated with hypertension. Only obesity [AOR = 2.81, (95% CI: 1.29–6.14)] was independently associated with hypertension. Conclusion: Hypertension affects one in every two adults aged 40 years and above in the Tamale Metropolis of Ghana. Awareness of adult hypertension status in the Metropolis is very low with the most diagnoses of the disease occurring accidentally. Obesity, advancing age, being male and being widowed are risk factors associated with hypertension. The study suggests workplace BP screening and a scale-up of awareness campaigns in the Metropolis to curb the incidence of the disease and control associated risk factors.
Udi Heru Nefihancoro, Muhammad Fariza Audi Putra
Journal of Advances in Medicine and Medical Research pp 214-220; https://doi.org/10.9734/jammr/2021/v33i1731046

Abstract:
Aims: To determine the effectiveness of 3, 6, and 9 liters of physiological saline for wound irrigation in grade II open fracture at lower extremity in reducing the number of bacterial colonies Study Design: This observational study determined the quantity of physiological saline for wound irrigation in grade II open fracture at lower extremity which is effective in reducing the number of bacterial colonies. Place of Study: Moewardi Hospital Emergency Room and the Microbiology Laboratory of the Faculty of Medicine, Universitas Sebelas Maret. Methodology: 16 patients with grade II open fracture at lower extremity who came and received treatment was included. Patients with grade II long bone open fracture less than six hours, patients with multiple open fractures of the long bones taken only in one place, patients who had not received medical treatment since the incident were included. Patients suffering from previous bone and/or soft tissue infections at the fracture site and suffering from multiple trauma who should receive immediate life-saving measures were included. Results: There were 12 patients who met criteria inclusion. After 3 L irrigation, there was a decrease in the amount of bacterial colony, same as 6 L irrigation, while there was no increase in the number of bacterial colonies in 9 L irrigation. There were significant differences in 3L, 6L, 9L irrigations (p = 0.001), but the most effective irrigation fluid was in 9 liters compared with 6 liters (p <0.05). Conclusion: Wound irrigation with 3, 6, and 9 liters of normal saline will significantly reduce the number of bacteria. However, irrigation with 9 liters of normal saline dilution in grade II open fracture at the lower extremity is the most effective.
Jude Nwaogu, Isah Musa Fakai,
Journal of Advances in Medicine and Medical Research pp 184-191; https://doi.org/10.9734/jammr/2021/v33i1731043

Abstract:
Vegetable oil has been used for cocking and ethnomedicinal purpose in developing countries. The aim of this research was to determine the toxicological effect of Balanites aegytiaca seed oil in albino rats. Acute and sub chronic toxicological evaluations were carried out on albino rats. The albino rats were divided into six experimental groups (n = 6 albino rats/ group). Five different doses of Balanites aegytiaca seed oil; 1000mg/kg, 2000mg/kg, 3000mg/kg, 4000mg/kg and 5000mg/kg were administered orally (gavage) to groups 2 – 6 respectively, once per day for 28 consecutive days. While control group received saline with Tween® 80 2%. Standard laboratory methods were used to assess liver and kidney functions indices. The acute toxicity screening revealed that the Balanite aegyptiaca seed oil (BASO) was non-toxic with LD 50 above 5000mg/kg. The liver function test parameters revealed non-significant (p>0.05) difference in serum AST and ALT activities between control group and treated groups. However, there is significant (p<0.05) increased of serum ALP activity in treated groups when compared to normal control group. Serum albumin concentration significantly (p0.05) in the concentration of total protein, total and direct bilirubin observed in treated groups when compared to normal control group. While kidney function test parameters showed alterations in serum creatinine and Potassium concentrations in treated groups compared to normal control group. Oral administration of B. aegyptiaca seed oil for 21 days did not displayed signs organs damage. The results suggest that prolonged consumption of Balanites aegytiaca seed oil could not cause adverse effects on the liver and kidney organs.
, Samah Ahmed Radwan, Ehab Mohamed El-Gamal, Mohamed Fouad Sherif
Journal of Advances in Medicine and Medical Research pp 192-201; https://doi.org/10.9734/jammr/2021/v33i1731044

Abstract:
Background: The combination of Functional magnetic resonance imaging with Diffusion Tensor Imaging has proven scientific and clinical relevance. By measuring the directed provides complementary information on white matter architecture, i.e., on the course and integrity of functionally important white matter tracts. In the diffusion of protons along myelinated fibers, Diffusion Tensor neuroimaging research is mainly applied to study the human brain's structural connectivity, whereas diffusion tensor tractography is often also employed for clinical applications. Diffusion Tensor Imaging measurements can be obtained together with Functional magnetic resonance imaging in the same scanning session, which gives an even more complete picture of each patient's brain. This study aimed to assess cerebral lesions affecting optic radiations by magnetic resonance imaging with diffusion tensor imaging tractography. Methods: Our prospective study was conducted on 30 cases ages ranged from 17-83 years, 10 of them were normal and considered as the control group and 20 patients were presented with clinical neurological symptoms and signs associated with visual abnormalities. Results: There is a significant difference between the Fractional anisotropy difference and difference ratio between the two groups with a p-value of 0.016 and 0.017 respectively. There was a strong significant positive correlation between Fractional anisotropy difference ratio (%) and tractography; r = 0.716 (95% confidence interval: 0.470 - 0.858) and p-value <0.001. We correlated the pathological types with different patterns of tractography. optic radiations fiber tracts were displaced in 83.3% of benign tumors and infiltrated in 16.3%. while in malignant tumors optic radiations fiber tracts were displaced in 75%, infiltrated in 12.5%, and disrupted in 25%. There is no "gold standard" for in vivo tractography. Diffusion Tensor Imaging is the only method that permits the calculation and visualization of fiber tracts trajectories in vivo. Conclusions: Diffusion Tensor Imaging tractography is clinically feasible and provides useful information regarding the site of optic radiations and their affection by different brain lesions also, surgical strategy for lesions located in eloquent visual areas. Also, there was a strong significant positive correlation between Fractional anisotropy difference ratio (%) and tractography distribution. Also, probabilistic multifiber tractography applied to diffusion Magnetic resonance imaging data acquired at 3T may be better as it can cope with crossing and kissing fibers than deterministic models because it allows many more possible local pathway orientations for each Diffusion Tensor Imaging sample point.
, Vivian Oparah
Journal of Advances in Medicine and Medical Research pp 177-183; https://doi.org/10.9734/jammr/2021/v33i1731042

Abstract:
Background: Most drug-substance abusers do have withdrawal symptoms considering the type of drug. Some of the symptoms include: changes in appetite, changes in mood, congestion, seizure, fatigue etc. These symptoms make it difficult for someone to effectively withdraw. It therefore means that for someone to effectively withdraw from drug abuse, there are other factors that must come into play to enhance success. Hence, this study was done to determine the contributing factors to stoppage of drug use among students in university of Port Harcourt’s host communities as an attempt to curb the menace and its effect on students and the entire society at large. Materials and Methods: The study was a descriptive cross-sectional study carried out in ALUU Community in Ikwerre Local Government Area of Rivers State between August 2019 and December 2019. The study involved 150 volunteers recruited randomly through a multi-staged sampling technique which included secondary school students, undergraduates who are 13yrs and above residing in ALUU community while those who did not give consent were excluded. The data was collected using self-structured close-ended self-administered questionnaires and data analysis done using SPSS version 25. Results and Discussions: The results of the study showed that the proportion of students that have stopped drug/substance abuse was 7.34%, the most prevalent age group at onset of drug use was 16-18yrs, and 26.42% of students used drugs/substance daily. The most prevalent reason for stopping drug use was personal decision 54.55%, while the least proportion was other reason 9.09%; Family and religious leaders had equal influence (45.45%) in the stoppage of drug/substance use by students. Conclusion: The results of the study showed that the most prevalent reason for stopping drug use was personal decision 54.55%, Family and religious leaders (45.45%) were the major contributing factors and had equal influence in the stoppage of drug/substance use by students.
Ali Farag Ali, Mohamed Mohsen El Namori, Ahmed El Sayed El Halwagy, Magdy Hassan Hussein Balaha
Journal of Advances in Medicine and Medical Research pp 167-176; https://doi.org/10.9734/jammr/2021/v33i1731041

Abstract:
Background: Intrauterine growth restriction (IUGR) is a condition in which the fetus does not reach its growth potential. It is well known that a fetus affected with late IUGR has smaller abdominal size. The aim of the study is to evaluate the fetal liver size, fetal hepatic artery blood flow and other fetal vascular Doppler indices in cases of late IUGR. Methods: This observational analytical, cross-sectional study was carried out on 100 pregnant women at or above 32 weeks. Participants were divided into two groups: Group 1 (study group): 50 pregnant women as study group who were affected with IUGR. Group 2 (control group): 50 normally pregnant women as control group. Results: There was no statistically significant correlation between fetal weight and liver length. There was a positive highly statistically significant correlation between symphysial fundal height and the estimated fetal weight by ultrasound in cases of IUGR. There was a statistically significant decrease in the liver size in IUGR compared to the normal group. There was a statistically significant reduced hepatic arterial Doppler indices. Conclusions: Reduced liver size and hepatic arterial Doppler indices (PI, RI) can be valid diagnostic methods in IUGR. SFH, in fetuses suffering from IUGR when compared to normal cases, was correlated with EFW.
, K. A. Rabiu, A. Gbadegesin, N. W. Okoh
Journal of Advances in Medicine and Medical Research pp 159-166; https://doi.org/10.9734/jammr/2021/v33i1731040

Abstract:
Background: Preeclampsia has continued to be a challenge especially in the areas of understanding the pathogenesis and prevention or treatment of the disease. Previous reports on the relationship between maternal lipids and preeclampsia have varied as its role in the aetiopathogenesis of pre-eclampsia is not clearly defined. This study aimed at comparing the lipid profile in preeclampsia with that in normotensive pregnancy. It also examined for any relationship between an abnormal profile and severe disease. Methods: This was a prospective case-control study. It was conducted among pregnant women who presented for routine antenatal care and those seen in the emergency room of the obstetrics unit of a tertiary institution in Lagos, Nigeria. The duration of the study was 6 months as it took place between May 2015 to October 2015. Pregnant women in their second half of pregnancy, diagnosed to have pre-eclampsia and, who gave consent were consecutively recruited as cases and pregnant women with similar age and gestational age, who had normal blood pressure were also selected as controls within the study period. The Maternal lipid profile was assayed using an enzyme-based assay kit and analysed according to the manufacturer’s instructions. All participants were followed up till delivery. Results: One hundred and seventy pregnant women in the third trimester of pregnancy participated in this study. They were within 18 – 45 years of age. More of the participants were nulliparous. Eighty-five of them had pre-eclampsia and constituted the study group while 85 were normotensive in the control group. The mean age was similar in both groups (control=29.59 ± 4.50 years versus pre-eclampsia=29.73 ± 5.10 years). The gestational ages at blood sampling of the patients in this study ranged between 27 – 40 weeks. The analysis of data revealed that the level of total cholesterol, triglycerides, low-density lipoprotein and very-low-density lipoprotein was higher in the cases compared with the control. This difference was statistically significant because the calculated P-value was <0.05. The level of high-density lipoprotein was lower in those with pre-eclampsia. Serum cholesterol and low-density lipoprotein were significantly higher (P-value= 0.04) in those with severe disease. A significant positive relationship was observed between mean arterial blood pressure and abnormal levels of lipids. Conclusion: An abnormal pattern of lipid profile was observed in women with preeclampsia and this was more marked in those with severe disease. A larger multi-centre study will be required to substantiate this finding.
Eman Basiouny, Faiza Lashin, Manal Hamisa, Amal Selim
Journal of Advances in Medicine and Medical Research pp 144-151; https://doi.org/10.9734/jammr/2021/v33i1731038

Abstract:
Aims: To assess hepatic steatosis and fibrosis in patients of type 2 diabetes mellitus (T2DM), their possible risk factors and their association with metabolic syndrome and micro or macro-albuminuria. Study Design: Cross sectional study. Place and Duration of Study: Outpatient Clinic of Diabetes, Metabolism and Endocrinology Unit in internal medicine department, Tanta University, Egypt in a period between September 2019 to March 2020. Methodology: We included 200 patients had a diagnosis of T2DM according to American Diabetes Association criteria. Then patients were assessed for presence of hepatic steatosis and fibrosis using fibroscan and we used liver stiffness measurements (LSMs, as a measure of fibrosis) and controlled attenuation parameter (CAP, as a measure of steatosis) and routine laboratory data were done to rule out possible risk factors. Results: 98.5% of participants had hepatic steatosis and 53.5% of participants had hepatic fibrosis. Those patients had longer duration of DM, higher BMI, bad control of T2DM, higher lipid profile values, association with metabolic syndrome, micro and macro-albuminuria and non-significantly elevated liver enzymes. Conclusion: Hepatic steatosis and fibrosis are highly prevalent in patients with T2DM, incidence of hepatic steatosis and fibrosis is positively correlated with longer duration of DM, higher BMI, bad control of DM, dyslipidemia, presence of metabolic syndrome, diabetic nephropathy, weakly correlated with liver enzymes. TE is an accurate and non-invasive tool to be used in screening for hepatic steatosis and fibrosis ,so we recommend screening for hepatic steatosis and fibrosis using fibroscan to help in early management and prevent its progression into liver cirrhosis.
Mazen Mohammed AlRassad, Mohammed Mohsen ElNamoury, Mona Khaled Omar, Manal Mostafa Abdallah
Journal of Advances in Medicine and Medical Research pp 152-158; https://doi.org/10.9734/jammr/2021/v33i1731039

Abstract:
Background: A cesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labor. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated. This study aims at determining the prevalence of isthmocele (niche) among those who gave birth through Cesarean section, and figure out how many of the women diagnosed with scar niche are symptomatic. Methods: This observational cross-sectional study involved 300 women who gave birth by CS at the latest 6 months and they were recruited from the outpatient clinics of obstetrics and gynecology department, Tanta university hospital. Results: The prevalence of the niche was 21.7%. And the most common shapes of niche documented were the semicircular defects followed by the triangular defects. The majority of cases were symptomatic while only 7.7% were asymptomatic and discovered accidentally by routine ultrasound examination. The most common symptoms documented were abnormal uterine bleeding (AUB), chronic pelvic pain, dysmenorrhea, and secondary infertility. There was a positive significant relationship between the number of CS, the size of the niche, and the severity or frequency of the presenting symptom (P value < 0.01). Conclusion: Cesarean scar niche has a strong statistically significant association with symptoms such as AUB (especially inter-menstrual bleeding), chronic pelvic pain, and dysmenorrhea. In our study, the prevalence of cesarean niche was 21.7% and the common niche shapes documented were the semicircular and triangular niches.
, Yomna Mazid Neinaa, Dareen Abd El-Aziz Mohamed, Nashwa Naeem El Far
Journal of Advances in Medicine and Medical Research pp 124-130; https://doi.org/10.9734/jammr/2021/v33i1731036

Abstract:
Background: Keloid is generally accepted to be the result of prolonged and aberrant wound healing. Botulinum toxin injections are considered an efficient therapy for keloids. The current study evaluated the efficacy and safety of intralesional injection of botulinum toxin in treatment of keloids. Methods: This prospective interventional study was carried out on 20 patients presented with keloids. Patients were treated by intradermal injection at the periphery of lesions by botulinum toxin as 100 IU diluted by 2 ml normal saline (5 IU/ cm3). Vancouver Scar Scale (VSS) and Verbal Rating Scale (VRS) were used for the assessment of the therapeutic efficacy. Results: There was a statistically significant improvement in all VSS and VRS parameters. Vast majority, 18 (90%) patients, were satisfied and 2 (10%) patient was not satisfied. There was non-significant correlation between the age of patients, duration of keloid nor size of keloid in relation to degree of improvement of VSS after treatment. There was positive significant correlation between VSS before treatment and degree of improvement of VSS after treatment. Conclusions: Intralesional injection of botulinum toxin was effective and safe therapeutic techniques in inhibiting keloids regarding the statistically significant improvement on comparing between before treatment and after the end of follow up period.
C. R. Aniemena, F. N. Ilika, P. O. Nwosu, P. O. Adogu, E. C. Azuike, M. C. Ohamaeme
Journal of Advances in Medicine and Medical Research pp 131-143; https://doi.org/10.9734/jammr/2021/v33i1731037

Abstract:
Aim: The use of various substances is very common among the populace. These agents are readily abused by adolescents and youths who are introduced to these substances at an early age in life. This thus leads to abuse and misuse that eventually has a catastrophic outcome to the society at large. The aim of this study was to determine the prevalence of substance use among in-school and out-of-school adolescents; a comparative analysis in Anambra State, Nigeria. Study Design: This was a cross-sectional comparative study. Place and Duration of Study: The study was conducted in schools, parks and markets of Onitsha municipal area of Anambra State, Nigeria, from September 2019-April 2020. Methodology: A total of 250 in-school and 250 out-of-school adolescents aged 10-19 years, within Onitsha municipal area was sampled through the use of a semi-structured interviewer administered questionnaire, that was adapted from a WHO designed instrument on drug use among non-student youths. Frequency distributions were developed, while associations between variables were tested using t-test, fisher’s test, and chi-square. Results: The results showed that most participants were males with mean ages of both sexes being 16.7 among the in-school and 16.1 in the out-of-school. There was statistically significant difference in alcohol consumption between in-school compared to out-of-school, p=0.001; and cigarette smoking, p=0.001. However, inhalants use was more among in-school compared to out-of-school, though not statistically significant. The overall prevalence of substance use was 58.4%, with 80.4% among the out-of-school compared to 36.4% with the in-school participants. Conclusion: Substance use is common among in-school and out-of-school adolescents. The prevalence of substance use was significantly higher among out-of-school compared to in-school adolescents. Parents should teach their children the dangers of substance abuse while Schools and governments should ensure inclusion of such in the curriculum.
Saad Abd Elmaseh Saad, Mohamed Elsayed Elsetiha, Mohamed Naseem Hussein, Fatma Aboalsoud Taha
Journal of Advances in Medicine and Medical Research pp 104-109; https://doi.org/10.9734/jammr/2021/v33i1731034

Abstract:
Background: dysfunction is associated with adverse outcomes in patients with congenital heart disease. RV adaptation to disease is complex and depends on many factors. 2D Speckle tracking echocardiography is an angle-independent technique that may allow an accurate assessment of segmental myocardial deformation. Aims: The aim of the work is to assess right ventricular function in patients with congenital left to right shunt (ASD) pre and 3 month post device closure using. Patients and Methods: 31 patients were enrolled in the study, comparison was held between the group and itself before and 3 month after device closure. ESPAP measurement via TR jet also Tricuspid annular. Global longitudinal Strain of RV free wall and septum were measured by 2D STE. Results: Volume overload on RV and according to Frank Starling law leads to increased contractility provided that function is preserved, so volume load in ASD cases leads to increased deformation and deformation rate values as evidenced in significant reduction of strain and strain rate values after volume load elimination. Strain and strain rate values gained via 2D speckle tracking echocardiography are load dependent parameter of contractility as evidenced in this study testing RV performance under both pressure and volume load. The value of these parameters of contractility assessment comes from their ability to detect subtle changes in mechanics and deformation that are not easily detected by conventional measures. Conclusion: Myocardial deformation imaging is a novel echocardiographic tool for evaluation of global and regional myocardial function that can be applied to the RV for assessment of its longitudinal deformation by 2DE. 2D-STE derived strain and strain rate is a good method to exclude the effect of tethering and translational motions. RV responds to volume load by increasing its deformation and deformation rate provided that contractile function is preserved.
, Samy A. Khodier, Ghada M. Al-Ghazaly, Ibrahim A. Nassar
Journal of Advances in Medicine and Medical Research pp 94-103; https://doi.org/10.9734/jammr/2021/v33i1731033

Abstract:
Objective: The aim of this study was to evaluate the utility of lung ultrasonography to determine the accuracy of prescribed dry weight in chronic hemodialysis patients and to ascertain the adequacy of fluid removal . Methods: In this cross sectional study LUS was performed immediately before and after (within 15 min) the dialysis session on 60 patients on regular hemodialysis, 4-hours per session, three times weekly at Tanta university hospitals, Internal Medicine Department, Nephrology units, Egypt. The ultrasonography B-lines was tabulated and compared to the intradialytic ultrafltration parameters and dry weight. Results: Positive significant correlation (P 0.02) was achieved between the intradialytic percentage change in B-lines and the percent change in total body weight reduction and also Positive significant correlation (P 0.05) was achieved between the intradialytic percentage change in B-lines and the ultrafiltration rate. Conclusion: LUS is a valuable diagnostic tool for recognizing the adequacy of fluid removal and to avoid inaccurate estimation of dry weight by usual clinical parameters or even radiologic studies including chest X-ray.
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