Journal of Advances in Medicine and Medical Research
ISSN / EISSN : 2456-8899 / 2456-8899
Published by: Sciencedomain International (10.9734)
Total articles ≅ 1,344
Latest articles in this journal
Published: 23 July 2021
Journal of Advances in Medicine and Medical Research pp 183-188; doi:10.9734/jammr/2021/v33i1631014
Aims: Parkinson’s disease (PD) is a common neurodegenerative disorder. As no definite diagnostic tests are available, diagnosis is done mostly clinically. UK Brain Bank criteria is commonly used globally for that purpose. In this study we used Movement Disorder Society (MDS) Clinical Diagnostic Criteria to diagnose PD and document the clinical presentations. Study design: Descriptive cross-sectional study. Methodology: This study was carried out in the department of neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from May 2018 to April 2019. Total 42 patients (4 clinically established and 38 clinically probable PD) were enrolled as study population according to Movement Disorder Society (MDS) Clinical Diagnostic Criteria - 2015 for PD. Their patterns of clinical presentation were recorded. Results: Among the PD patients, 31 were male and 11 were female. Mean age of all patients was 59.43 ± 11.34 years. The most common presenting feature was tremulous movement (90.5%) followed by slowness of movement (40.5%). Only 9% patients had early onset PD. All patients had history of positive response to dopaminergic therapy with documented resting tremor in 95.2%, and end-of-dose wearing off in 75.6%. Constipation was the commonest (69%) non motor symptom followed by sleep dysfunction (64.3%) & depression (50%). On examination- 100% patients had bradykinesia, 97.6% rest tremor, 95.2% rigidity, 21.4% mild dementia and 4.8% moderate dementia. Also 26.2% patients were found to have postural hypotension. 4 patients had red flag features- urinary retention was found in three patients and one patient suffered from recurrent early fall. Conclusion: MDS Clinical Diagnostic Criteria help in accurate diagnosis of PD and include more clinical features which will help in formulating management plan.
Published: 23 July 2021
Journal of Advances in Medicine and Medical Research pp 176-182; doi:10.9734/jammr/2021/v33i1631013
Background: Anaemia in pregnancy is an indirect cause of maternal mortality. Myriad of factors predispose pregnant women to anaemia in pregnancy in the developing countries of the world of which poverty, illiteracy and ignorance are central. The prevalence of anaemia in the developing countries of the world is between 32% and 62.2%. Objective: To determine the prevalence of anaemia amongst antenatal clinic attendees in Ogoni, South-South Nigeria and offer preventive measures. Material and Methods: This was a retrospective four months cross-sectional study of antenatal clinic attendees at booking in three (3) primary health care facilities and general hospitals Bori and Tera, in Ogoni, South-South Nigeria. Three hundred and eighty (380) pregnant women’s biodata including their packed cell volume were collected. These pieces of information were computed using a structured proforma. The data were coded and analysed using statistical package for social sciences (SPSS) software version 25. Results: The mean age of the study antenatal clinic attendees was 28 years. The mean gestational age at booking was 25weeks. The range for the packed cell volume was 25% to 36% and the mean packed cell volume at booking was 30%. Three hundred and eighteen (318) (84.0%) had anaemia (with packed cell volume less than 33%). Majority of patients 249 (65.6%) had mild anaemia There was none with severe anaemia. Majority of patients had secondary level of education represented by 275 (72.3%). Conclusion: The prevalence of anaemia amongst antenatal clinic attendees at Ogoni was 84.0%. The role of pre-pregnancy care amongst women desirous of pregnancy, familly planning and the role of education cannot be over emphasized in the prevention of anaemia in pregnancy.
Published: 22 July 2021
Journal of Advances in Medicine and Medical Research pp 155-165; doi:10.9734/jammr/2021/v33i1631011
Background: Huge volumes of local anaesthetics used in conventional blocks may be associated with complications. Hyaluronidase is an enzyme that hydrolyses hyaluronic acid in the tissue. It has been shown to aid the spread of local anaesthetics (LA) through tissue. The aim of this study was to compare between the addition of morphine or hyaluronidase to local anaesthetic in sonar guided supraclavicular brachial plexus block regarding the onset and duration of the block, postoperative analgesia and the total analgesic requirements in the first 24 hours. Patient and methods: Seventy-five patients of American Society of Anaesthesiologists (ASA) physical status I & II, aged 18-60 years, scheduled to acute or elective elbow, forearm or hand surgery under sonar guided supraclavicular brachial plexus block at Tanta University Hospital were randomly allocated into three equal groups; Group I (Control group) received 20 ml containing 9 ml bupivacaine 0.5% and 9 ml lidocaine 2% plus 2 ml normal saline, group II (Morphine group) received 20 ml containing 9 ml bupivacaine 0.5% and 9 ml lidocaine 2% plus 5 mg morphine in 2 ml normal saline and group III (Hyaluronidase group) received 20 ml containing 9 ml bupivacaine 0.5% and 9 ml lidocaine 2% plus 1500 units of hyaluronidase in 2 ml normal saline. The onset of sensory and motor block, duration of sensory and motor block, postoperative VAS, time to first rescue analgesia, total morphine consumption and possible side effects were recorded. Results: Onset of the sensory block and motor block was significantly shorter in the hyaluronidase group than control group and morphine group. Duration of the sensory block and motor block was significantly prolonged in morphine group than hyaluronidase group & control group. VAS started to increase at 6 hours in the control group, at 10 hours in morphine group and at 8 hours in hyaluronidase group. Time to first rescue analgesia was significantly prolonged in morphine group than control group and hyaluronidase group. Total analgesic consumption of morphine was significantly lower in morphine group than control group and hyaluronidase group. Conclusion: Morphine was superior to hyaluronidase as regarding to improving the post-operative pain. The incidence of complications was nil and self-limited in the three groups.
Published: 20 July 2021
Journal of Advances in Medicine and Medical Research pp 123-131; doi:10.9734/jammr/2021/v33i1631008
Aims: To quantify the contribution of ultrasonography (US) as a complementary tool to electrodiagnostic evaluation of traumatic lesions of median and ulnar nerves after surgical repair" Patients and Methods: The study included a total of 50 nerves from 40 patients with traumatic injury of wrist median and/ or ulnar nerves. Patients were evaluated at one and three months after primary nerve repair clinically, electrophysiological, and US examinations. Results: No significant difference (p = 0.125) was found between classification of injury by electrodiagnosis and by US. Good agreement between clinical assessment of the motor power and the severity of injury based on electrodiagnosis was found. Moderate agreement between clinical assessment of motor power and continuity of the repaired nerve based on US was noted. Good agreement between the severity of the injury by electrodiagnosis and the continuity of the repaired nerve by the US (p <0.001*) was detected. The sensitivity of US in detecting nerve continuity was 87.9% one month after repair and 80% after three months. Conclusion: As a supplement to electrodiagnostic testing, the US can offer a noninvasive and complementary tool for assessing post-operative repair of traumatic nerve lesions with respect to their exact location, course, continuity, extent, and neuroma formation and can be of value in the visualization of the morphological abnormalities associated with nerve injuries, including swelling and perilesional scar tissue formation.
Published: 14 July 2021
Journal of Advances in Medicine and Medical Research pp 53-58; doi:10.9734/jammr/2021/v33i1631001
Introduction: In Africa, inguinal hernia is a common surgical condition with an incidence of 175 inguinal hernias per 100,000 people each year. Pain that persists for at least a duration of 3 months postoperatively following repair of an inguinal hernia defines chronic groin pain. The objective of this study was to determine the prevalence of chronic groin pain in a group of patients in a hospital setting in rural Africa. Methodology: A descriptive retrospective study was carried out between 1st April 2008 to the 31st July 2012 on all patients ≥15 years of age that underwent an inguinal hernia repair were eligible in this study. Data was retrieved from patients’ clinical notes and theatre log books on age, sex, recurrence of hernia and post-operative pain lasting at least 3 months. Data obtained in the interview questionnaire included duration of pain, pain at the operation site, type of postoperative analgesia and a physical examination to determine recurrence was performed in the surgical-out-patients clinic. Results: One hundred and fifty eight patients following repair of inguinal hernia using the modified Bassini technique were analysed. Mean age was 44.84 years. The male:female ratio was 3.65:1 with a male predominance. Chronic groin pain/discomfort was reported in 22(13.92%) and this pain/discomfort lasted for at least 3 months post-operatively. Conclusions: The low incidence of chronic groin pain in our study may be due to the majority of them being operated as elective procedures under local anaesthesia with routine identification of the ilioinguinal nerve. However, a study with a larger sample size and a longer follow up may be required to ascertain the true prevalence of chronic groin pain following inguinal hernia surgery in rural Africa.
Published: 12 July 2021
Journal of Advances in Medicine and Medical Research pp 138-147; doi:10.9734/jammr/2021/v33i1530994
Background: Cervical cancer is the second most common cancer in women globally after breast cancer. It is a preventable cancer with a well‑defined premalignant phase where treatment could be offered before invasive cancer develops. Objective: To determine the prevalence, socio-demographic characteristics and serotypes of high-risk HPV amongst positive women using self-sampling HPV-based cervical cancer screening. Methods: A cross-sectional pilot study in an urban setting in Lagos, Nigeria where one hundred women, following community-based counselling on cervical cancer and its prevention, underwent cervical cancer screening via self-sampling for hr-HPV. Structured questionnaires were administered for data collection. Appropriate instruction for self-sample collection using Flobam cervical sampling kit was given to each subject. The samples were processed using DNA analysis via PCR (polymerase chain reaction) amplification and flow through hybridization to identify the hr-HPV serotypes. Women who tested positive for hr-HPV had colposcopic-guided biopsy. The data obtained were analysed using SPSS version 20.0. Findings: Almost all (97%) the women were successful at self-sampling. The prevalence of hr-HPV positivity was 19% with peak (31.6%) of hr-HPV positivity observed in subjects aged 31-40 years. HPV 53 was the commonest (36%) serotype, HPV 33 and 39 were the least (7%) identified and 47% of hr-HPV positive subjects had infection with two or more HPV serotypes. Two-third (66.7%) of hr-HPV positive subjects attended follow-up for colposcopy guided biopsy and 10.5% of the hr-HPV positive subjects had premalignant/malignant cervical lesion. Conclusion: Infection with more than one hr-HPV serotype is common in our study. Self-sampling modality of HPV cervical cancer screening is feasible in this environment.
Published: 12 July 2021
Journal of Advances in Medicine and Medical Research pp 123-137; doi:10.9734/jammr/2021/v33i1530993
Malaria is a parasitic disease that causes morbidity and mortality in many areas of the world especially in Sub-Saharan Africa and particularly in Cameroon. It is characterised by febrile manifestation, liver inflammation and anaemia. Toxoplasmosis is another parasitic infection caused by an obligate intracellular parasite (Toxoplasma gondii) and is found in many countries of the world. It causes spontaneous abortion in pregnant women and hydrocephally in new- born babies. Malaria and Toxoplasmosis co-infections can cause serious pathological consequences on both mother and fœtus. The aim of this study was to determine the prevalence of malaria, toxoplasmosis, and malaria and toxoplasmosis coinfection in pregnant women during ante natal consultations at Biyem - Assi hospital and to assess their knowledge of the pathological consequences of malaria, toxoplasmosis, and coinfection on the mother and baby. It was a cross-sectional study. Blood samples were collected by finger-prinking and structured questionnaires were administered to 226 pregnant women. The results showed that 39.38 %, 23 % and 8.4 % of women tested positive for malaria, toxoplasmosis and coinfection respectively. The most commonly cited consequence of theses infections was spontaneous abortion. The results obtained showed a significant association between the level of education and the level of knowledge of women about toxoplasmosis and coinfection of toxoplasmosis and malaria (p < 0.05). The level of knowledge of the pregnant woman is not satisfactory as regards toxoplasmosis and co-infection but quite good as regards malaria. The studies have revealed the need for continouos education on toxoplasmosis for pregnant women and girls of childbearing age, and more comprehensive preventive measures. The implementation of public health and education policies that take into account economic, social, environmental and cultural differences are of prime importance.
Published: 10 July 2021
Journal of Advances in Medicine and Medical Research pp 113-122; doi:10.9734/jammr/2021/v33i1530992
Aim: The aim of this study is to evaluate initial and short-term result of duplex guided angioplasty (DGA) for treatment of femoropopliteal arterial lesions. Methods: From October 2017 to September 2020, 50 limbs in 50 patients (30 males) underwent DGA in our institution. The study was conducted on patients suffered from chronic lower limb ischemia of grade IIb, III and IV (according to Fontaine Classifications) resulting from femoropopliteal lesions (occlusion or stenosis). Arterial access was done under duplex guidance followed by advancing a guidewire across the diseased femoropopliteal segment(s). The diseased segment(s) were then balloon-dilated. Intimal dissection or residual stenosis causing diameter reductions greater than 30% were stented with a self-expandable stent under duplex guidance. Completion duplex examinations and ankle brachial indices were obtained after the procedure. Results: The mean age of patients was 64 ±8 years. Critical ischemia was the indication in 44%, and disabling claudication was the indication in 6% of cases. Technical success was achieved in 46 cases (92%). 31 cases (62%) went through transluminal crossing of the lesions using duplex guidance alone, 11 cases (22%) went transluminally using duplex combined with contrast-free fluoroscopic assistance and 4 cases (8%) was subjected to subintimal angioplasty using combined techniques. Stenting was done in 24 cases (48%), 16 cases (32%) were having floating intimal flap; while the other 8 cases (16%) had residual stenosis > 30%. A primary patency rate of 92% was obtained by the end of the 12 months follow-up period. Conclusion: Duplex can be used as a first strategy for the treatment of femoropopliteal arterial diseases. However, the pitfalls in DGA technique make it insufficient to replace the classic fluoroscopy.
Published: 9 July 2021
Journal of Advances in Medicine and Medical Research pp 99-112; doi:10.9734/jammr/2021/v33i1530991
COVID-19 has rampaged across continents and has caused a devastating impact on life, economy, mobility, and health. Vaccines are still under clinical trials however there is no immediate solution or drug at hand for effective treatment. During this time, finding an unorthodox solution has become the need of the hour. Nigella sativa, commonly known as the black seed has been widely used as a traditional medicine in the past to fight illnesses. Chief compounds of N. Sativa seed, especially thymiquinone, α‐hederin, and nigellidine, could be developed into promising herbal drugs to combat COVID‐19 due to their therapeutic benefits. Extensive studies on N. Sativa have demonstrated its wide spectrum pharmacological properties which include immunomodulatory, analgesic, anti-inflammatory, antiviral, bronchodilatory, hepato-protective, reno-protective, gastro-protective, and antioxidant properties that can serve as a potent inhibitor for SARS-CoV-2. Furthermore, N. Sativa has also exhibited antidiabetic, antihypertensive, and antibacterial properties which would help COVID-19 patients with comorbidities. The objective of this review is aimed at establishing a link between the pharmacological benefits of N. Sativa and its potential to serve as a cure for COVID-19.
Published: 7 July 2021
Journal of Advances in Medicine and Medical Research pp 82-91; doi:10.9734/jammr/2021/v33i1530989
Purpose: To evaluate and compare the effectiveness of lateral rectus muscle recession with Y-splitting versus recession only in the surgical treatment of up/down shoot in Duane retraction syndrome patients. Material and Methods: In this prospective study, 42 patients of Duane retraction syndrome with up/down shoot underwent surgery over a period of seven years, were divided into two groups of twenty one each. In group A, Y-splitting of lateral rectus with recession and in group B, only lateral rectus recession was performed. In all the patients width of lateral rectus muscle at its insertion was measured. Postoperative results were compared and analyzed in terms of up/down shoot on adduction. Data analysis was performed using R Core Team (2020) R., and the P value <0.05 was taken as significant. Results: The Mean age at the time of surgery was 12.5 ± 4.5 years in group A, and 11.5 ± 3.9 years in group B (range, 5 to 22 years). Correction of up/down shoot was 100% in group A and 81% in group B. Five patients in group B showed no improvement of up/down shoot in whom the width of lateral rectus was 7mm or less and the surgery was recession of lateral rectus only. In these 5 patients, Y-splitting of lateral rectus was done in second sitting with good result Mean follow up was 12 months (range, 3 weeks to 3 years). Conclusions: Recession of lateral rectus muscle with Y-splitting is more effective (100%) when compared to recession only, in correcting significant up/down shoot in Duane retraction syndrome. Lateral rectus muscle Y- splitting is not necessary in these patients with upshoot / down shoot if the width of the muscle at insertion is within normal limits (8.3 -12.5 mm). In these cases simple recession is enough. Lateral rectus muscle Y splitting is essential when the width of lateral rectus muscle at insertion is 7mm or less.