Open Access Case Study

Chronic Periaortitis – Review and Presentations

Savita Taribagil, Sabrina Bhattacharya, Priyal Taribagil, Vadivelu Saravanan, Vish Bhattacharya

Journal of Advances in Medicine and Medical Research, Page 15-25
DOI: 10.9734/jammr/2020/v32i1130527

Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case shows a classic picture of IgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery.

Open Access Short Research Article

An Evaluation of Hand Hygiene Practice by Health Care Personnel at a Tertiary Hospital in North Eastern Nigeria

I. A. Imoudu, M. G. Zirami, A. B. Zamo, I. E. Idiodemise, L. M. Mahmood, H. Sambo, I. U. Abdul

Journal of Advances in Medicine and Medical Research, Page 26-32
DOI: 10.9734/jammr/2020/v32i1130529

Background: Hand hygiene when done satisfactorily is one of the most effective ways of preventing hospital acquired infections. However elementary the process may seem, it is one that has been shown to significantly elude health care personnel (HCP). This study aimed at assessing the knowledge, attitude and practice of hand hygiene by HCP at the Federal Medical Centre (FMC) Azare, North-Eastern Nigeria.

Methods: The study was a cross sectional survey of HCP who make direct contact with patients at four randomly selected units of FMC Azare. Using the purposive sampling technique, a structured questionnaire was administered on the respondents. The collected data was analyzed using the statistical package for social sciences (SPSS) version 20.0. Presentation of data was done with tables, in proportions and percentages.

Results: Eighty-two (82) HCP were recruited into the study, 64 (78.0%) were males and 18 (22.0%) were females, giving a ratio of 3.6:1. Nurses made up 43.9%, health assistants 34.1% and doctors 22.0% of the total number. The respondents exhibited a good knowledge of hand hygiene (93.2%). Seventy- seven (93.9%) of the respondents showed a positive attitude while 6.1% had a negative attitude towards hand hygiene. All categories of respondents had good practice scores regarding hand hygiene.

Conclusion: The knowledge, attitude and practice of hand hygiene of HCP at FMC Azare is optimal. However, continuous training on infection prevention and control with emphasis on hand hygiene and other strategies is recommended to allow for improvement in compliance to the concept of standard precautions.

Open Access Opinion Article

Stem Cell Modelling in COVID-19

Rajeev Nagpal, Akriti Srivastava, Victor Ekuta

Journal of Advances in Medicine and Medical Research, Page 33-36
DOI: 10.9734/jammr/2020/v32i1130530

The ability of stem cells to differentiate into any desired cell type can make them an indispensable tool in COVID-19 modelling studies. Stem cells derived from patients with preexisting conditions or derived from vulnerable populations such as children, can also assist scientists in understanding the unique contributions of these diverse factors to variations in COVID-19 infection responses. Innovative approaches are urgently needed to adequately address the global impact of COVID-19. Stem cell based strategies offer such an approach.

Open Access Minireview Article

Bariatric Surgery in Adults: Patient Workup and Preparation

Ravi Kant, Shankar Roy, Pradeep Yadav KL, Monika Pathania

Journal of Advances in Medicine and Medical Research, Page 8-14
DOI: 10.9734/jammr/2020/v32i1130526

With the advancement and industrialization of our society, the prevalence of metabolic disease is also increasing. Among the risk factors for metabolic syndrome and many other non-communicable diseases, obesity is the single most important one. Although life style and pharmacological therapies are the part of initial intervention, however once the overt obesity related complication appears, bariatric surgery becomes the only curative intervention. Various modalities surgeries have come into place in recent times. However preparing a patient physically and mentally needs a thorough pre- operative preparation. Here in this review, we are exploring the approach to patient with morbid obesity and work up for bariatric surgery from a physician’s point of view.

Open Access Original Research Article

Evaluation of External Abdominal Wall Hernia Surgery in a Secondary Level Facility in Kumasi, Ghana

Samuel Mensah, Patrick Opoku Manu Maison, Ishmael Kyei, George Adjei Adjei, Martin T. Morna, Samuel Debrah, Ganiyu A. Rahman

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/jammr/2020/v32i1130524

Aims: We aimed at auditing hernia surgeries performed at a secondary care center and determine the outcome of surgery based on the grade of operating surgeon.

Study Design: A single center retrospective study.

Place and Duration of Study: Department of Surgery of Ashanti regional Hospital between October 2015 to September 2018.

Methodology: We included 259 patients, age ranging between 1 and 84 years, who underwent external hernia surgeries. Information retrieved included patient demographics, type of hernia, duration of hernia, whether hernia was emergency or elective, method of repair, whether surgery was performed by a surgeon or non-surgeon and early post-operative complications. Data was analyzed using PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc SPSS. Bivariate analysis was done to ascertain relationship between complications and operating doctor.

Results: A total of 259 hernia surgeries were performed over the study period. There were 186 (71.8 %) males and 73 (28.2 %) females, age range of 1 to 84 years. There were 66 (25.5%) children and 193(74.5%) adults. Children in their first decade were the majority (22.4%) age group followed by adults in their 5th decade (17%).  Inguinal hernia was the most common (75.7%) type of hernia, 49 (18.9%) children and 147(56.6%) adults. There were 32 (12.4%) emergencies. Small bowel (20) was the most common content found in the hernia sac with 6 of them being gangrenous. Hematoma was the most common early complication. The majority (63.7%) of the cases were performed by the general surgeon and (20.1%) by house officers (interns) under supervision. Complications like haematoma, surgical site infection and acute urinary retention were more likely to occur in the non-surgeon operators. There was no statistically significant relation between the grade of operating surgeon and Haematoma (p = 0.28) and surgical site infection (p= 0.76).

Conclusion: Hernias are common in children in the first decade and in adults in the 5th decade. With a well-structured training programme non-surgeon physicians can be trained to perform hernia surgeries with relatively low complication.

Open Access Original Research Article

Comparative Study between the Effect of Perineural versus Intravascular Dexmedetomidine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Mahmoud A. Al Mohasseb, Wael E. Messbah, Sabry M. Amin, Nadia H. Fattooh

Journal of Advances in Medicine and Medical Research, Page 37-45
DOI: 10.9734/jammr/2020/v32i1130531

Background: Augmentation of postoperative analgesia with various adjuvants has become a standard in regional anesthesia. There are no studies about dexmedetomidine multiple approaches in supraclavicular brachial plexus block (BPB) was contrasted. We compare perineural dexmedetomidine and intravenous dexmedetomidine Bupivacaine as adjuvant in supraclavicular brachial plexus block.

Materials and Methods: This prospective randomized controlled double-blind study was conducted on 120 patients with age between 20 and 60 years, both sexes, scheduled for elective upper limb surgery. Patients were randomly allocated into 3 groups, 40 patients in each received plain bupivacaine 0.5% (20 ml) in supraclavicular BPB; group I (Control group): add 1 mL normal saline perineural, group II: Bupivacaine with perineural dexmedetomidine (BDP) add 1 μ perineurally. group III: Bupivacaine with intravenous dexmedetomidine (BDV) add 0.5 μ dexmedetomidine in 50 mL of normal saline administered as infusion over 10 min. Onset and duration of sensory and motor blocks, hemodynamic variables, adverse effects, and duration of analgesia were assessed.

Results: Heart rate and mean arterial pressure was significantly decrease in group III &group II compared to group I were compared by ANOVA (F) test. onset of sensory &motor block was statistically significant shorter in group II compared to group I & III. Duration of sensory &motor block was statistically significant longer in group II compared to group I & III. there was statistically significant decrease VAS in group II were analysed using Kruskal-Wallis test between three groups. There was statistically significant increase RSS in group II & III. The first time of analgesic request was statistically significant prolonged in duration in group II.

Conclusion: Perineural dexmedetomidine (1 µg/ kg) as an adjuvant to bupivacaine is significantly high thanIV dexmedetomidine (0.5 µg/ kg) and bupivacaine alone in supraclavicular BPB as regards to the onset and the duration of sensory block, so Increasingpostoperative analgesia.

Open Access Original Research Article

Prevalence of Cardio-metabolic Risk Factors among Young Saudi Women with Vitamin D Deficiency

H. A. Al Kadi, E. Alissa

Journal of Advances in Medicine and Medical Research, Page 46-55
DOI: 10.9734/jammr/2020/v32i1130532

Aims: The aim of this study was to determine the prevalence of cardio-metabolic risk factors in apparently healthy Saudi women with vitamin D deficiency.

Study Design: A retrospective chart review.

Place and Duration of Study: This study was conducted in the Center of Excellence for Osteoporosis Research (CEOR), King Abdulaziz University, Jeddah, Saudi Arabia, between June 2015 to October 2015.

Methodology: Healthy women 20–40 years old, with no history of previous illnesses and not on any medications were included in this study. Data on anthropometric measurements as well as blood pressure (BP) were obtained. Body mass index (BMI) was calculated. Laboratory results including fasting blood glucose (FBG), fasting lipid profile, 25-hydroxyvitamin D3 (25(OH)D3) and parathyroid hormone (PTH) were also obtained. Vitamin D deficiency was defined as 25(OH)D3 concentration <50 nmol/l. Modified NCEP:ATPIII criteria were used to define cardio-metabolic risk factor cutoff points.

Results: A total of 305 women were included in the current analysis. Mean (± S.D.) age of the study group was 28.4±6.1 years and median (IQR) 25(OH)D3 was 17.8 (11.9–28.2) nmol/l. Almost 97% of the study participants were vitamin D deficient and 70% had values below 25 nmol/l. 25(OH)D3 was significantly inversely associated with waist circumference, systolic and diastolic BP and PTH (P=0.011, <0.0001, <0.0001, <0.0001, respectively). Prevalence of cardio-metabolic risk factors were higher among participants who fell in the lowest tertile of 25(OH)D3 except total cholesterol and low density lipoprotein cholesterol, however only higher PTH was statistically significant (P=0.022).

Conclusion: The results of the present study confirm the high prevalence of vitamin D deficiency among otherwise healthy Saudi women. The results also suggest that the prevalence of selected cardio-metabolic risk factors is higher among those with low vitamin D status. Prospective studies are needed to determine whether such deficiency will be of clinical significance with advancing age in this population, and whether vitamin D supplementation has beneficial effects.

Open Access Original Research Article

Azadirachta indica (Neem) Leaf Extract Effect as an Option of Treatment of Ibuprofen-induced Nephrotoxicity

Ifeanacho Ezeteonu Abireh, Onyinye Mary Ozioko, Ignatius Ikemefuna Ozor, Elizabeth Finbarrs- Bello, Uche Sebastine Ozioko, Franklin Egbo

Journal of Advances in Medicine and Medical Research, Page 56-62
DOI: 10.9734/jammr/2020/v32i1130533

Aim: This study investigated the curative effect of the aqueous leaf extract of Azadirachta indica on Ibuprofen-induced nephrotoxicity in Wistar rat

Study Design: This is an experimental research

Place of Research: Department of Anatomy, College of Medicine, Enugu State University of Science and Technology.

Methodology: Twenty-four male Wistar rats were divided into 6 groups, with 4 rats in each group. Group 1 was control and received oral normal saline 0.5 ml daily. Group 2-6 had induction of nephrotoxicity using oral Ibuprofen 400 mg/Kg daily for 5 days. Group 3-5 were subsequently treated with gavage Azadirachta indica leaf extract 200 mg/Kg, 400 mg/Kg and 800 mg/Kg, respectively, for 5 days. And Group 6 was treated with oral Vitamin E 1000 iu/kg for 5 days.

Results: Ibuprofen induced nephrotoxicity as evidenced by elevation of serum creatinine level in group 2 (1.99 ± 0.83), when compared to 0.48 ± 0.07 obtained in group 1 (control), and Bowman’s capsule enlargement with glomerular degeneration observed in group 2. The serum creatinine levels progressively approached the level of that of the control in groups treated with Azadirachta indica leaf extract, groups 3 (1.69 ± 0.52), 4 (0.69 ± 0.10) and 5 (0.49 ± 0.10). Also, the histoarchitecture progressively normalized to that of control with each increase in dose of the extract.

Conclusion: Azadirachta indica (neem) leaf extract administration led to the resolution of Ibuprofen-induced kidney injury in this study. Thus, it can serve as a treatment option for kidney injury resulting from ingestion of Ibuprofen, after the identification of the molecule responsible for this effect.

Open Access Original Research Article

Bringing Otorhinolaryngological Service to Workplaces: Impact of World Hearing Day

I. O. Akpalaba, O. T. Olarinoye, F. O. Ogisi

Journal of Advances in Medicine and Medical Research, Page 63-71
DOI: 10.9734/jammr/2020/v32i1130534

Introduction: Individuals do not seek otorhinolaryngological service due to busy schedules at workplaces. Aim of this study was to identify common and asymptomatic otological conditions and profer solutions; to determine the awareness of otorhinolaryngological services in workplaces.

Methods: A 2-year prospective study done in 2017 and 2018 from 3rd to 31st March of these years, in Edo and Ondo states respectively. Study centers were Independence Television, Nigerian Television Authority; God is Good Motors, De Modern Motors, First Bank, Hope and Echos Hospitals in Benin City; Trauma center and Main auditorium UNIMED in Ondo state. Study was to mark the World Hearing Day. It commenced after obtaining clearance, permissions and informed consents. Total sampling technique was used. Health education was given. Self-administered questionnaires were completed. Otoscopy was done, each ear regarded as a separate entity. Wax and foreign bodies found were removed. Those with ear pathologies were referred to centers with otorhinolaryngological facility for further management. Data analyzed with SPSS, 20. P<0.05 was considered statistically significant.

Results: 192 participants, representing 384 ears were examined. Age ranged from 16 to 68 years. Commonest otological condition was Otitis media with effusion in 36.7% and 33.3% in Edo and Ondo states respectively. Commonest asymptomatic condition was Cerumen auris. Awareness of ORL services was 60% and 85.1% in Edo and Ondo states respectively. Association between demographics and awareness was statistically significant with age, education and occupation.

Conclusion: Otological diseases abound in individuals at workplaces. Though there is high level of awareness, there is presence of asymptomatic otological conditions.

Open Access Original Research Article

Comparison of Serum Level of Bone Resorption Markers with Bone Densitometry in Elderly Individuals in Port Harcourt, Rivers State

Kiyesi Adekemi, Ehimen Phyllis Odum, Victor Chukwuma Wakwe

Journal of Advances in Medicine and Medical Research, Page 72-79
DOI: 10.9734/jammr/2020/v32i1130535

Introduction: This study concentrated on serum bone markers, N and C- telopeptide and tartrate resistant acid phosphatase (TRAP), and their concentrations were evaluated in the serum of elderly participants and compared with that of the young of the same gender. Markers for bone resorption are proteins, and they are mainly measured in the urine and serum, where they serve to assess bone turnover.

Methodology: A cross-sectional prospective study conducted at the orthopaedic and Family Medicine Departments of the University of Port Harcourt Teaching Hospital, a public tertiary healthcare facility located in Choba and Alakahia communities of Obio/Akpor Local Government Areas of Rivers state, Nigeria, among elderly patients aged 60 years and above.

Results: Considering the age of the test population, all the females were post-menopausal and no statistical difference was observed in relation to the results for gender in the study. Also, the plasma creatinine, calcium and albumin results of both controls and participants were within normal reference range. The study was necessitated by the fact that, in the environment of the study (Port Harcourt), elderly individuals frequently complain of bone pain, thus, the serum levels of the aforementioned bone resorption markers (N and C telopeptide and tartrate resistant acid phosphatase) was estimated among these elderly individuals, with the view that its outcome can help physicians to initiate protocols that will prevent the consequences of increased bone resorption, intervenes before bone becomes fragile and aid the prediction of osteoporosis.

Conclusion: This study was able to establish that the serum levels of NTX, CTX and TRAP were increased in elderly participants above the age of sixty years than controls.

Open Access Original Research Article

Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes

Heba H. Zayed, Karim Sabry, Yasser M Abdelraouf, Wessam M. Salah, Ingy Abdel Wahab, Mabrouk R EL- Sheikh

Journal of Advances in Medicine and Medical Research, Page 80-91
DOI: 10.9734/jammr/2020/v32i1130536

Our Study Aimed: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on obese T2DM patients, its effect in remission of diabetes and role of gastrointestinal Glucagon like peptide 1(GLP1) and Peptide tyrosine tyrosine (PYY) hormones. Metabolic surgery should be recommended as an option in type 2 diabetic patients (T2DM) with body mass index (BMI) ≥40 Kg/m2, in patients who have BMI ≥35 Kg/m2 and in selected patients with BMI < 35 Kg/m2, if not achieving diabetes control with maximum tolerated anti-hyperglycemic treatment.

Methods: 30 T2DM patients with BMI ≥ 40 kg/m2 underwent laparoscopic sleeve gastrectomy after full clinical evaluation, routine blood tests, glucagon like peptide 1, Peptide tyrosine tyrosine (fasting, 0.5-hour post-mixed meal test (MMT) serum levels) and upper GIT endoscopy. Follow-up visits were at 3, 6 and 9 months postoperatively to evaluate body weight, BMI and glycated hemoglobin (HbA1C) and at 18th month for confirmation of diabetes remission. Gut hormones were measured at 15 days and 9 months postoperatively.

Results: (53.3%) of patients had partial remission of T2DM according to HbA1C remission criteria. There was significant increase in fasting and post-MMT levels of peptide tyrosine tyrosine, glucagon like peptide 1 postoperatively. The only independent predictors for remission of T2DM were the baseline serum low density lipoprotein cholesterol (LDL-Ch), duration of diabetes, preoperative post MMT Peptide tyrosine tyrosine plasma level, serum thyroid stimulating hormone (TSH) and age.

Conclusions: laparoscopic sleeve gastrectomy can induce partial remission of diabetes in younger patients who had shorter duration of diabetes, higher level of preoperative post-MMT peptide tyrosine tyrosine, lower levels of preoperative serum LDL-Ch and thyroid stimulating hormone.