Journal of Advances in Medicine and Medical Research
ISSN / EISSN : 2456-8899 / 2456-8899
Published by: Sciencedomain International (10.9734)
Total articles ≅ 1,488
Latest articles in this journal
Published: 12 October 2021
Journal of Advances in Medicine and Medical Research pp 176-182; https://doi.org/10.9734/jammr/2021/v33i2031120
A 60-year-old male patient, weighing 40 kg, having a BMI of 13, who was also a known case of Diabetes Mellitus Type II was shifted to the Orthopaedic Ward last month due to a fall, which led him to develop an intertrochanteric fracture in the femur. While the treatment of the patient was in an ongoing status for his fracture, his Diabetes was seen to be poorly controlled, with his blood glucose levels being constantly evaluated to be in a state of severe hypoglycaemia to slightly increased levels of blood glucose. On examination, the patient showed clear signs of being malnourished. He was in a bad and dishevelled state, he had creases on the palmar aspects of his hands and hyperpigmentation on his buccal mucosa. Furthermore, his lab reports revealed abnormalities in nearly every lab test ordered. Not only did he have elevated ACTH levels, but there was also a failure of Cortisol stimulation. His DEXA Scan showed that he was predisposed to develop severe osteoporosis and his malnourished condition was supportive of promoting that condition even more. The patient was diagnosed to be suffering from Autoimmune Polyglandular Syndrome, Type II. This is a rare condition of one of its kind where there is a pre-existence of autoimmune adrenal insufficiency along with either autoimmune thyroid disease or autoimmune diabetes mellitus. Since this condition is rare, it tends to often get overlooked upon diagnosis, leading to misdiagnosis because almost all of the presenting features or the symptoms of the prevalent endocrinological disorders present in this condition mimic either hypothyroidism, or diabetes, or adrenal insufficiency alone, and thus lead to further consequences when the condition does not resolve despite persistent treatment, such as the case in this patient. This paper reviews the background of the patient and the causes that possibly could have made him reach this advanced stage of the disease. The paper also reflects upon the disease, Autoimmune Polyglandular Syndrome Type II, as a whole and elaborates on the symptoms and signs which the patient tens to confuse with other endocrinological diseases. Lastly, this paper shall also review the appropriate management plan for the patient to ease his symptoms and accelerate his recovery process.
Published: 9 October 2021
Journal of Advances in Medicine and Medical Research pp 170-175; https://doi.org/10.9734/jammr/2021/v33i2031119
Aims: The main goal of the following case report was to shed the light on the importance of thorough clinical, radiological and histological examinations in order to elaborate a final diagnosis of asymptomatic dentigerous cysts detected in unusual locations. Presentation of Case: A case of dentigerous cyst was identified accidentally in the maxillary left premolar region of an asymptomatic 14-year-old female post an orthodontic consultation. Histological examination of the tissue specimens following enucleation confirmed the diagnosis of a dentigerous cyst. Discussion: Dentigerous cysts are the second most common odontogenic cysts after radicular cysts. They involve impacted, un-erupted, permanent, supernumerary, odontomas and rarely deciduous teeth. Dentigerous cysts are usually painless but may cause facial swelling and delayed tooth eruption. Extensive maxillary involvement and childhood presentation are rare. Radio-graphic and histological examinations should be done to confirm the diagnosis of a dentigerous cyst. Conclusion: In our case, we showed the presence of a maxillary premolar dentigerous cyst that was removed by enucleation. The presence of dentigerous cyst is not always associated with a syndrome and its removal is very important to avoid future complications.
Published: 7 October 2021
Journal of Advances in Medicine and Medical Research pp 162-169; https://doi.org/10.9734/jammr/2021/v33i2031118
Introduction: Breast cancer is major burden worldwide and the majority of breast cancers express estrogen receptors (ER) suggesting a high dependence on estrogen hormone. Age is among the major determinants of breast cancer development, however, although Western Kenya is one of the areas with high breast cancer cases, age distribution of ER-positive breast cancer in the sub-region remains largely undocumented. Differentiation-related gene-1 (DRG1) is a metastasis suppressor and thus a potential biomarker for predicting level of metastasis but its potential application in assessing extent of metastasis of ER positive breast cancer has not been fully explored. This study therefore investigated the age distribution and the potential of expression of DRG1 in assessing metastasis of ER positive breast cancer. Materials and Methods: Breast cancer tumour blocks archived in safe cabins in the histology laboratory section, Moi Teaching and Referral hospital, Eldoret, Kenya were used. Clinico-pathological parameters such as histology grade, tumor size, which are associated with metastatic cancer, were assessed using the archived clinico-pathological reports and/or histological analysis of the tumour blocks. Expression of DRG1 and Ki-67 proteins were determined using immunohistochemistry. Results: ER positive breast cancer was predominant among women aged 40 and 50 years. No association was observed between immunohistochemical expression of DRG1 and parameters such as histology grade, tumor size or expression of Ki-67 protein expressed DRG1 (p > 0.05). Conclusion: The findings suggest that expression of DRG1 protein is not associated with parameters that indicate breast cancer metastasis. Thus, DRG1 expression is not a potential biomarker candidate for ER positive breast cancer metastasis. However, since the small sample size was used, further research using larger prospective study is necessary to support the present findings.
Published: 7 October 2021
Journal of Advances in Medicine and Medical Research pp 155-161; https://doi.org/10.9734/jammr/2021/v33i2031117
Background: Reno-vascular disease is a complex disorder, the most common cause of which is RAS. Multi detector computed tomography angiography (MDCTA) plays an important role in assessment of the renal vasculature. Despite conventional angiography is still considered the gold standard in reno-vascular imaging, MDCTA is increasingly used as it is less invasive, easily applicable and available. Aim of the Study: In our study we aimed to assess the role of CT Angiography in diagnosis of renal vasculature abnormalities. Patients and Methods: This prospective study was carried out at The Radio-diagnosis and Medical Imaging Department in our institute, conducted on 40 Patients who are clinically suspected to have reno-vascular abnormalities in the period from September 2018 to February 2021. Their ages ranged from 33 to 56 years old. Results: Based on CTA findings, out of 40 patients, 6 (15%) patients were confirmed to have accessory renal arteries, 6 (15%) patients had renal artery aneurysm, 6 (15%) patients had nutcracker syndrome, 6 (15%) patients had dual venous drainage of both kidneys, two of them showed retro-aortic left renal vein &10 (25%) patients were confirmed to have renal artery stenosis. Conclusion: CT Angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with reno-vascular lesions involving the proximal renal vessels. MDCT angiography is advantageous being a non-invasive technique that can be done on outpatient basis without pre or post-procedure admission, no special post-procedure care and less cost.
Published: 7 October 2021
Journal of Advances in Medicine and Medical Research pp 146-154; https://doi.org/10.9734/jammr/2021/v33i1031116
Aims/Purpose: The aim of this study was therefore to document the frequency and pattern of serum cholesterol in stroke patients admitted in a tertiary hospital in Enugu. Methods: This was a descriptive cross-sectional study carried out at Enugu State University Teaching Hospital Enugu. Serum cholesterol levels were classified based on the current international cut off points for people with cardiovascular disease. Statistical analysis of data was carried out using SPSS version 22. Results: Data from a total of 180 subjects were collected and analyzed. The mean (sd) of serum cholesterol fractions and their distributions are: Low density lipoprotein 2.4± 1.18 mmol/l, High density lipoprotein, 1.17± 0.62 mmol/l, Total Cholesterol, 4.43± 1.34 mmol/l, and triglycerides 1.21±0.77 mmol/L. HDL-cholesterol was significantly lower in patients 50 years and older. P=0.02. A total of 12 (6.7%) of the patients had high levels of LDL, 92(51.1%) had poor levels of HDL. Between stroke types, 10(7.2%) of patients with ischemic stroke had high serum LDL compared to 2(4.8%) with hemorrhagic stroke p= 0.32. Among those with hemorrhagic stroke, 22(52.4%) had poor levels of HDL compared to 70(50.7%) of those with ischemic stroke p= 0.17. Total cholesterol and triglycerides were also found in a higher proportion of those with ischemic stroke than hemorrhagic although these differences were not statistically significant. Conclusions: There mean level of serum LDL, HDL and TC are higher in stroke patients than recommended values. Current recommended universal use of statins after stroke should be encouraged in both ischemic and hemorrhagic stroke.
Published: 6 October 2021
Journal of Advances in Medicine and Medical Research pp 136-145; https://doi.org/10.9734/jammr/2021/v33i2031115
Background: The association between tuberculosis (TB) and diabetes mellitus (DM) is re-emerging with the epidemic of type II diabetes. Both TB and DM were of the top 10 causes of death. This study explores diabetes mellitus as a risk factor for developing the different antitubercular drug-resistant (DR) patterns among TB patients. Methods: A retrospective cohort study has been conducted on all TB cases reported to the King Abdul Aziz University Hospital, Jeddah, between January 2012 to January 2021. All culture-confirmed and PCR-positive TB cases were included in this study. Categorical baseline characteristic of TB patient has been compared with DM status by using Fisher's exact and Pearson chi-square test. The univariable and multivariable logistic regression model was used to estimate the association between DM and different drug resistance patterns. Results: Of the total 695 diagnosed TB patients, 92 (13.24%) are resistant to 1st line anti TB drugs. Among 92 DR-TB patients, 36 (39.13%) are diabetic. The percentage of different patterns of DR-TB with DM, in the case of mono DR (12.09%), poly DR (4.19%) MDR (0.547%). As a risk factor, DM has a significant association with DR-TB, mono drug-resistant, and pyrazinamide-resistant TB (P-value <0.05). The MDR and PDR separately do not show any significant association with DM, but for further analysis, it shows a significant association with DM when we combined. Conclusion: Our study identified diabetes mellitus as a risk factor for developing DR-TB. Better management of DM and TB infection caring programs among DM patients might improve TB control and prevent DR-TB development in KSA.
Published: 5 October 2021
Journal of Advances in Medicine and Medical Research pp 127-135; https://doi.org/10.9734/jammr/2021/v33i2031114
Background: Laparoscopic repair of umbilical and paraumbilical hernia has largely replaced conventional (Open) repair. The purpose of the study was to compare the effectiveness of laparoscopic vs. open repair of umbilical & para umbilical hernia in a tertiary care government hospital. Methods: A total 50 patients of age >18 years diagnosed with umbilical and paraumbilical hernia who underwent laparoscopic and open hernia repair from May2018 to Nov 2020 were enrolled and divided into two groups of 25 patients in each. The patients were followed up in the post-operative period in the wards during daily rounds till the time of discharge; 1 and 6 months after discharge and yearly. Results: The mean age for open group was 44.24±7.68years while the mean age for laparoscopic group was 50.0±11.82years. Operative time was more in laparoscopic repair (81.68±18.37min) as compared to open (55.44±16.54min). Post-operative pain (VAS score) was greatest in the open group in comparison to lap group at 6 hr, 24 hr, day 8 and at 1month. Postoperative overall complication rate (Infection, seroma and recurrence) was 12% in the laparoscopic group and 28% in the open group. Recovery was faster with laparoscopic repair with a mean postoperative hospital stay of 3.28days as compared to 5.88days for open mesh repair. Patients treated with laparoscopic repair were early return to routine activity and work. Conclusion: The laparoscopic approach appears to be safe, effective and acceptable. It is a complex but very efficient method in experienced hands and it offered a significant advantage over open repair.
Published: 2 October 2021
Journal of Advances in Medicine and Medical Research pp 116-126; https://doi.org/10.9734/jammr/2021/v33i2031113
Background: Preeclampsia (PE) is a disorder that causes hypertension and proteinuria after week 20 of pregnancy. Several Uterine Artery (UtAs) Doppler characteristics have been investigated for their ability to predict PE. The purpose of this research is to look into the uterine and umbilical arterial Doppler indices in the early second trimester for the prediction of late preeclampsia or intrauterine growth restriction. Methods: This is a prospective cohort clinical study and was done at Obstetrics and Gynecology department, faculty of medicine Tanta university hospital from January 2020 till April 2021. 150 pregnant women aged from 18 to 30 years old with gestational age from 13 to 16 weeks of pregnancy. Study was done by the same observer by machine MINDRAY DC60 Measurement of fetal biometry (BPD, FL, AC, HC) Gestational age was confirmed with Detection of congenital malformation. Results: There is a significant difference between the groups regarding uterine and umbilical artery doppler Indices. Uterine RI only yielded significance for predicting IUGR with sensitivity of 62% and specificity of 88%, with Positive predictive value (PPV) 37% and Negative predictive value (NPV) 92%. Umbilical resistance index achieved sensitivity of 56% and specificity of 82%, with PPV 31% and NPV 30% with on statistical significance. Conclusions: Combination of uterine and umbilical artery Doppler study in early pregnancy is one of the best indicator for prediction of preeclampsia and IUGR. Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.
Published: 2 October 2021
Journal of Advances in Medicine and Medical Research pp 105-115; https://doi.org/10.9734/jammr/2021/v33i2031112
Aims: To investigate the association of iron and vitamin B12 status with coronary artery disease in Gaza city. Study Design: A Case control study Place and Duration of Study: Samples were collected from the cardiac unit at Al-Shifa hospital, Gaza Strip. Methodology: Case-control study was conducted on a sample of 31 patients with coronary artery disease (CAD) and 27 apparently healthy controls aged between 30-60 years. Interviewed questionnaire was conducted among the study population. Vitamin B12, serum ferritin, serum iron, lipid profile parameters, and high sensitivity C reactive protein were performed. An approval was acquired from Helsinki ethical committee to perform this study. All data were analyzed by SPSS. Results: The results showed that the mean level of serum iron in cases (71.6 ± 24.7 µg/dl) was lower compared to that of controls (87.3 ± 28.4 µg/dl) and the difference was statistically significant (P=.028). Moreover, transferrin saturation percentage in cases (24.0 ± 8.9%) was lower compared to controls (29.0 ± 9.9%) and the difference was statistically significant (P=.045). In addition, the mean levels of serum vitamin B12 in cases (238.8 ± 51.4 pg/dl) was lower compared to controls (337.3± 108.4 pg/dl) and was statistically significant (P<0.001). The Pearson correlation test showed that there was a significant positive correlation between the level of serum iron with the level of vitamin B12 among the participants (r = 0.28, P=.032). Conclusion: The mean differences of transferrin saturation, serum ferritin, and vitamin B12 between cases and controls were statistically significant. The mean levels of serum vitamin B12 in cases was lower compared to controls and was statistically significant.
Published: 1 October 2021
Journal of Advances in Medicine and Medical Research pp 93-104; https://doi.org/10.9734/jammr/2021/v33i2031110
Background: Mean sac diameter (MSD) is a sonographic measurement of the gestational sac which is usually first seen at around 5 weeks, when it measures about 2-3 mm, It's the average of measurements taken in three dimensions.Crown rump length (CRL) defined as the length of the embryo or fetus from the top of it's head to bottom of torso, it's the most accurate estimation of gestational age in early pregnancy, it's determined by the average of three measurements of the longest fetal length. Aim of the study Determine efficacy of mean sac diameter minus crown rump length (MSD-CRL) in prediction of early pregnancy outcome. Methods: The study included 80 cases at (6:9) gestational weeks with singletone pregnancy. We examined the case at the initial visit, Mean sac diameter and Crown rump length were calculated for each case. The difference between the MSD and CRL in mm was calculated. Then follow up visit after two weeks later. Pregnancy outcome was then recorded between (11:14w). During transvaginal ultrasound (TVUS) we observed location, size, number and regularity of gestational sac. Cardiac pulsation & Presence or absence of sub-chorionic hematoma. Results: 73 cases (91, 3%) continued normal pregnancy and 7 cases (8, 8%) had pregnancy failure. It was found that the age, body mass index, gravidity and history of abortion show insignificant relation with outcome (p >0.05). Area under a curve was 0.984, p Value was <0.001, 95% CI was (0.961 – 1.000), at the cut off value (MSD-CRL) less than or equal 4, the sensitivity was 71.4%, the specificity was 97.2%, PPV was 71.4% and NPV was 97.3%, while at cut off value less than or equal 5, the sensitivity was 100.0%, specificity was 95.89, PPV was 70.0% and NPV was 100.0%. Conclusions: (MSD- CRL) is good prediction for early pregnancy outcome but, the optimum threshold for predicting pregnancy outcome needed to be established by further studies, also bigger sample size will provide more advantage.