Open Access Case Study

Sigmoid Volvulus in Pregnancy Mimicking Abruptio Placenta

Khairunnisa Che Ghazali, Nutrimala Nadia Nasip, Ahmad Junaidi Ahmad Hamidi, Karthigesu Aimanan, Siti Nur Hamizah Hamidon, Chin Tek Jee, Aisah Munirah Wahi

Journal of Advances in Medicine and Medical Research, Page 85-88
DOI: 10.9734/jammr/2021/v33i230810

Sigmoid volvulus complicating pregnancy is a rare condition with significant maternal and fetal morbidity and mortality. Therefore, a high index of suspicion is needed, and additional radiological imaging is beneficial if both mother and fetus are stable.  A 28 years old lady, gravida 2 para 1 at 32 weeks gestation, with history of one previous LSCS for acute fetal distress, presented to our labour ward with generalised abdominal pain. A diagnosis of placental abruption was made, and patient was subjected to emergency LSCS for immediate delivery of the baby. A high index of suspicion of sigmoid volvulus should be suspected when a pregnant lady presents with a clinical triad of abdominal pain, distention, and absolute constipation. Timely surgical intervention reduces maternal and fetal morbidity and mortality.

Open Access Minireview Article

Microsurgery Training: Are the Live Models Era Coming in to the Tail? – A Literature Review

M. M. Hosain

Journal of Advances in Medicine and Medical Research, Page 97-109
DOI: 10.9734/jammr/2021/v33i230812

Introduction: Microsurgery is a relatively new speciality with steep learning patterns. Before practice in real fields surgeons need adequate training to gain the expertise. Different types of living and non-living simulators are used to gain the efficiency. As the living simulator has issues with complexity, availability, cost, ethical approval and special setting and available resources an alternative less complex, inexpensive, no ethical issues, easily available, effective non-living models are demanded by the trainers.  

Objective: Review the relevant articles to see the justification of use of live models for microsurgery training and to see is there any alternative non-living model to replace living model.

Materials and Methods: A PubMed and Google Scholar search for key words ‘(microsurgery) AND (training)) AND (live models)) AND (non-living models)) AND (education)’ were performed in February 2021.  Total 422 literatures were found from January 1990 to February 2021. Among them 29 were found relevant with topics. Among them 17 were finally selected for discussion.

Conclusion: Evidences showed non-living low fidelity models are as effective as high fidelity living model in microsurgery training. Many of the studies with ex vivo models have showed promising results which support replacement of live models in basic and intermediate courses. However, those are not sufficient to support for total ban of live models specially in advance microsurgery courses. We are hoping, in near future some blended non-living models may come up using digital or virtual reality technology which can replace the live model era. Further research with highest level of evidences are required. 

Open Access Original Research Article

Multi Slice Computed Tomography in Assessment of Posterior Mediastinal Lesions

Nora Mostafa Mohamed El Shalakany, Samah Ahmed Radwan, Abdelhady Mohamed Taha, Mohemed Fathy Dawoud

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/jammr/2021/v33i230802

Background: Posterior Mediastinal lesions are relatively common and represent 23-30% of all mediastinal lesions; 40% of these lesions are an incidental finding. Multidetector CT (MDCT) has shorter imaging time and better spatial resolution than MRI, especially in mediastinum; it is more widely available & less expensive. The additional role of CT is in performing CT guided biopsies if needed. This study aimed to evaluate the role of MSCT in the diagnosis of mediastinal lesions based on the characteristic imaging appearances, which can lead to a correct diagnosis and optimal management. The post-processing technique further improves the diagnosis and surgical planning.

Patients and Methods: This study included 30 patients with posterior mediastinal lesions evaluated according to clinical data, diagnostic imaging procedure (MSCT), and histopathological evaluation. Most of the cases in this study had a lesion raised from the LN and vessels by 23.3%.

Results: Metastatic lymphadenopathy was the commonest lesion in our study, 13.3%, followed by lymphoma 10.3% and neurogenic tumors 10%. Benign lesions were 60%, while the malignant lesion represents 40% of all cases. Multiple CT features of each posterior mediastinal lesion were used to predict the nearest histological diagnosis. The accuracy of MSCT in our study was 93.3%.

Conclusion: MSCT has a practical and significant role in the assessment & evaluation of the posterior mediastinal lesions according to the anatomical origin, the CT feature of the lesion (solid or cystic), density, the effect on the surroundings, the distribution pattern, and extent of the lesion.

Open Access Original Research Article

Relationship between Cervical Sagittal Parameters and Health Related Quality of Life in Cervical Degenerative Disc Diseases

Ahmed A. Bostan, Ali M. Emran, Ahmed E. El-Tantawy, Mohammed S. Saeid

Journal of Advances in Medicine and Medical Research, Page 9-22
DOI: 10.9734/jammr/2021/v33i230803

Introduction: The evaluation of the differences in radiological cervical sagittal parameters between symptomatic and asymptomatic individuals with radiologically- confirmed (CDDD) is fundamental for understanding the normal variation in sagittal plane parameter between individuals, to determine the age-related changes, to know the predictive sagittal parameters for unfavorable clinical symptoms and to determine the factors that participate in economic sagittal balance (compensation) in asymptomatic subjects. This will provide radiographic guidelines for the assessment and management of cervical spine patients.

Objectives: This study aimed to evaluate the relation between the radiological cervical sagittal parameter changes with the presence and severity of symptoms as well as quality of life in CDDD individuals, and provided radiographic guidelines for the assessment and management of cervical spine patients.

Methodology: The first 100 subjects who have visited the Outpatient clinic of Orthopedic Department in Tanta University Hospitals with radiologically-confirmed CDDD with or without clinical symptoms were reviewed. The individuals were divided into 2 groups for analysis and comparison. Group1 included the first 50 patients with symptomatic CDDD. Group2 included another 50 individuals with asymptomatic CDDD in their radiographs who visited the outpatient clinic as a relative to other patients or complained from other transient musclo-skeletal symptoms not affecting their quality of life.

Results: In the Analysis of the relationships between the data of the 2 groups: There were no statistically significant differences between each of the age, sex, occupations, and BMI in comparison between the 2 groups. The T1S angle was the only significant parameter in correlation between 2 groups. In the Analysis of the relationships between the data in the symptomatic group: There was a statistically significant increase in each of the T1S, C2-C7 lordosis, C2-C7 SVA with increasing the age. T1S was significantly lower in farmers and manual workers than in housewives and office workers. There was a significantly inverse correlation between each of the CL, T1S, T1S-CL and VAS. There was a significantly positive correlation between each of the CL, T1S, T1S-CL and modified EQ-5D-3L score. In the Analysis of the relationships between the data in the asymptomatic group: There was a significant increase in each of the TIA, T1S and NT with increase age, with an insignificant increase CL and with a significant decrease in C2-C7 SVA. There were insignificantly inverse correlations with each of the CL, TIA and T1S.

Conclusions: There is no difference in the C2–C7 lordosis curvature between the symptomatic patients and the asymptomatic individuals. The T1S is significantly lower in the symptomatic patients than in the asymptomatic individuals. So, Low T1S is a risk for the occurrence and development of cervical disc degeneration.

Open Access Original Research Article

Hand Hygiene: Knowledge and Practice among Healthcare Workers in the Paediatrics and Neonatal Intensive Care Unit of the Cape Coast Teaching Hospital

Peter Appiah-Thompson, Josephine Ashong

Journal of Advances in Medicine and Medical Research, Page 23-33
DOI: 10.9734/jammr/2021/v33i230804

Aims: To assess the knowledge of hand hygiene among health care workers in the Paediatrics Department and Neonatal Intensive Care Unit (NICU) of the Cape Coast Teaching Hospital (CCTH). To determine the hand hygiene practice among health care workers. To determine the barriers to hand washing practices in the Paediatrics Department.

Study Design: A cross-sectional descriptive study design was done.

Place and Duration of Study: Department of Paediatrics between 14th February, 2020 to 12th March ,2020

Methodology: 81 health workers including 31 doctors and 50 nurses (35 working nurses and 15 nursing students) who have direct contact to patients on the wards were included in the study. A World Health Organization (WHO) adopted self-administered questionnaire on hand hygiene was used.

Results: From the study, 75.3% of the respondents had fair knowledge on hand hygiene and 24.7% also had poor knowledge. Most doctors generally had a better knowledge of hand hygiene whilst nurses generally had poor knowledge. With a p-value of 0.002, a statistical association was found between having received formal education and the performance of routine hand hygiene practices.  Some barriers affecting hand hygiene practice included forgetfulness, lack of time and lack of alcohol-based hand rub.

Conclusion: In conclusion, most of the health care workers had a fair knowledge on hand hygiene with a few having poor knowledge. Majority of health care workers reported they routinely use hand washing and alcohol hand rub in their daily practice.

Regular education and practice of hand hygiene are essential to prevention of spread of diseases especially during this time of the Covid-19 pandemic.

Open Access Original Research Article

Correlation between Fetal Renal Blood Flow and Fetal Kidney Volume in Normal and Growth Restricted Fetuses

Noura Magdy Sonkor, Diaa Mounir Aglan, Amr Mohamed Tawfek, Walid Mamdouh Ataallah

Journal of Advances in Medicine and Medical Research, Page 34-44
DOI: 10.9734/jammr/2021/v33i230805

Background: Some trials have shown decreased weight of fetal kidney in cases of reduced neonatal weight and infants with growth-restriction at birth.   In infants with growth-restriction due to poor nutrition, most of the fetal blood supply is directed to vital organs such as fetal heart and brain that leads to deprivation of remaining organs from its nutrients, such as kidney. This work aimed to assess whether the size of fetal kidney in cases of normal and restricted fetal growth patterns after 28 weeks could be affected by reduced fetal renal blood supply or not.

Methods: This case-control trial included 60 patients who were divided into two groups: Each group composed of 30 patients; Study group: fetuses with IUGR and control group: fetuses with normal growth pattern.

Results: There was no significance between both study groups as regard to age, weight, BMI, and gravidity. No significance between the studied groups regarding the clinical findings, gestational age, diabetes, HTN, congenital fetal anomalies, and previous C.S. A high significance was present among both groups as regard to measurements of renal artery Doppler. A correlation of statistical significance was noted as regard Doppler indices and kidney volume in the study group.

Conclusions: The elevated pulsatility index of the renal artery of fetus in fetuses with IUGR showed -ve correlation with the volume of the fetal kidney, resulting in reduced nephron-genesis and perfusion. Restrictions in intrauterine growth are believed to be associated with a significant reduction in renal volume compared to the normal growth of fetuses. The Doppler of renal artery also reveals significant differences among study groups.

Open Access Original Research Article

Study of Ischemia-Modified Albumin as Marker of Vascular Injury in Diabetic Nephropathy

Asmaa Hassan Abd-Elaziz, Hossam Abd-Elmohsein Hodeib, Abeer Abd-El Moneim Shahba, Amal Selim

Journal of Advances in Medicine and Medical Research, Page 45-55
DOI: 10.9734/jammr/2021/v33i230806

Background: Diabetes mellitus (DM) is strongly correlated to ischemia caused by stress that is involved in dysfunction of endothelium leading to angiopathy, particularly diabetic nephropathy (DN). Immediately after occlusion of an artery, free radical production paired with reduced antioxidant defensive response and related ischemia in DM result in changes in the tertiary structure of human serum albumin; therefore, it is called ischemia-modified albumin (IMA). The aim of our work was to evaluate IMA as marker of vascular injury in DN.

Patients and Methods: This trial was conducted on 25 normal individuals as a control group (I) and 75 cases with type II DM. Cases have been subdivided into Group II: 25 diabetic cases with normal albumin in urine, Group III: 25 diabetic cases with albumin in urine and glomerular filtration rate >60 ml/min/1.73m2 and Group IV: 25 diabetic cases with albuminuria and glomerular filtration rate <60ml/min/1.73m2. Medical history, clinical features and laboratory investigations which include the serum IMA have been carried out to all cases.

Results: Compared to the control group, considerably greater serum levels of IMA have been reported in Diabetic cases there had been a wide variation in IMA among the 4 groups. There were considerable +ve correlations among serum IMA and DM duration, blood urea, serum creatinine, UACR, FBS, PPBS and HBA1c. A considerable -ve correlation among serum IMA and eGFR was observed. IMA had an optimal cutoff value≥90 ng/ml with 0.92 area under ROC curve, 96% sensitivity and 92% specificity (p-value<0.001).

Conclusion: IMA could function as a glycemic control marker and a sensitive indicator for DN.

Open Access Original Research Article

The Role of Platelet Indices in Prediction of Pre-eclampsia

Walaa Abdelghafar Elbasuony, Hossam Abd el-mohsein Hodeib, Adel Elshahat Eljejawy, Karam Abd el-fattah Shaheen

Journal of Advances in Medicine and Medical Research, Page 69-77
DOI: 10.9734/jammr/2021/v33i230808

Objective: The aim of this work is to investigate the diagnostic value of platelet count (PC), mean platelet volume (MPV), the PC to MPV ratio and platelet distribution width (PDW) for prediction of pre-eclampsia (PE).

Subjects and Methods: This prospective cohort study included 100 pregnant women, in the first trimester of pregnancy attending to University Hospital, Obstetric Outpatient Clinic, for routine obstetric care from January 2019 to December 2019. Routine obstetric follow-up consists of monthly visits until 32nd gestational week, bimonthly visits between 32nd and 36th gestational week, and weekly thereafter. Patients were classified into two groups: group I: 9 pre-eclamptic patients and group II: non pre-eclamptic 91 patients. CBC indices were measured at each planned visit

Results: PC, PC/MPV were significantly decreased, MPV and PDW were significantly increased in group I than group II at the 2nd part of pregnancy. To predict pre-eclampsia, PC at cut-off ≤214, sensitivity was 77.78, specificity was 76.92. MPV at cut-off >9.7, sensitivity was 77.78, specificity was 100.00, PC-MPV at cut-off ≤26.89, sensitivity was 88.89, specificity was 78.02. PDW at cut-off >10.4, sensitivity was 88.89, specificity was 54.95.

Conclusion: The increase in the MPV and PDW and the decrease in PC and PC/MPV were observed in preeclampsia. Thus, the platelet indices which are easily available, as well as economical, can also be used in the prediction and early diagnosis of preeclampsia.

Open Access Original Research Article

Assessment of Knowledge about Iron Deficiency Anemia among the Adult Women in Selected Hospitals of Dhaka City

Tania Sultana, Israt Jahan, Md Jahangir Alam Sarker, Khaleda Ferdous, Abul Kalam Shamsuddin, Md Ranzu Ahmed

Journal of Advances in Medicine and Medical Research, Page 78-84
DOI: 10.9734/jammr/2021/v33i230809

Iron deficiency is one of the most common nutrient deficiencies, affecting 2 billion people in worldwide. It is also the leading cause of anemia. Estimates of the national prevalence of anemia in Bangladesh have remained constant at 74% for the past 30 years. This high rate of anemia is a major public health concern for Bangladesh. The aim of the study was to determine the knowledge level about Iron Deficiency Anemia (IDA) & nutritional status among the adult women and the pregnant women in the selected hospitals of Dhaka city. A descriptive cross-sectional study was conducted for the study. A pretested semi-structured questionnaire was used for the data collection. The results showed that, majority of the respondents 140 (70%) were pregnant and 60 (30%) were non pregnant among 200 respondents. The Mean ± (sd) age of study population was ±33 years. From all respondents the literacy rate of women were maximum (69%) but knowledge about IDA & nutritional status were not enough at all. Among the respondents the knowledge about IDA & nutritional status of adult women were 23% good, 40% moderate and 37% very poor. In pregnancy period 74% of the respondents did not take their iron related drugs regularly. Most of the adult women and the pregnant women were not significant knowledgeable regarding IDA, nutritional education & modified dietary habit. So, campaign for awareness on healthy life style practice is required for reducing this problem. Overall Government approach is also recommended for the lower prevalence rate of IDA.

Open Access Original Research Article

Role of Optical Coherence Tomography Angiography in Following-up Choroidal Neovascular Membranes during the Course of Aflibercept Therapy

Ahmad R. Ziada, Mostafa Abd El Latif Abo El Einen, Hamdy Abd El Azim El Koumy, El Said Ibraheem El Dessouky

Journal of Advances in Medicine and Medical Research, Page 89-96
DOI: 10.9734/jammr/2021/v33i230811

Aims: To evaluate the mean area of choroidal neovascularization (CNV) and the flow area within the CNV and determine their value in monitoring the effect of aflibercept therapy.

Study Design: prospective, interventional study.

Place and Duration of Study: Tanta University Hospital in the period between March 2017 and March 2019.

Methodology: OCT angiography images were obtained using the AngioVue (Optovue Inc., CA, USA). For quantitative analysis of the mean area of CNV and the flow area within the CNV, the CNV was manually delineated with the help of the manufacturer’s automated software, and the parameters of interest were automatically calculated and generated.

Results: The study included forty eyes of 40 patients, 14 females and 26 males, the mean age of patients was 69 ± 5 years. The mean baseline best-corrected visual acuity (BCVA) was 51.29 ± 14.80 ETDRS letters, which significantly increased to 63.41 ± 5.03 at week 36; p-value < 0.05. The mean area of choroidal neovascularization decreased significantly from baseline (2.72 ± 4.29 mm2) to week 36 (1.53 ± 1.07 mm2); p-value < 0.05. The the flow area within the measured CNV decreased significantly from baseline (2.28 ± 2.08 mm2) to week 36 (0.91 ± 0.63 mm2); p-value < 0.05.

Conclusion: The mean area of CNV and the flow area within the measured CNV are valuable biomarkers for following up CNV during treatment with aflibercept.

Open Access Original Research Article

Stress among Physicians Working in a Medical University Hospital

A. S. M. Rizwan, Shahida Akhter

Journal of Advances in Medicine and Medical Research, Page 110-117
DOI: 10.9734/jammr/2021/v33i230814

Introduction: Stress is an indispensable part of modern life. Although unavoidable, persistent stress can have a negative physical and psychological impact on anyone. Medical professionals are historically high stress professional cohort. The current study aimed to elucidate the stress among a divergent group of physicians at a tertiary teaching institute.

Methods: This cross-sectional descriptive study was done among 150 participants who were enrolled by non-randomized sampling. General Health Questionnaire was used to gather data that were analyzed using SPSS 20.

Results: Our study revealed that, staggering 48% of participants were distressed. Male doctors were more distressed than their counterparts. Graduate doctors had a higher score in comparison to the post-grad Doctors. Age was not a significant factor determining stress.

Conclusions: While treating others for their ailments, doctors tend to ignore their own health. Mental stress has a huge impact both on the Doctor suffering from it and the pool of patients served by him/her. This should attain more attention to prevent physician burnout.

Open Access Review Article

Stereotactic Radiosurgery and Targeted Therapies for Brain Metastases from Solid Cancers

Berrin Pehlivan, Erkan Topkan, Ahmet Kucuk, Ayse Okumus, Duygu Sezen, Ugur Selek

Journal of Advances in Medicine and Medical Research, Page 56-68
DOI: 10.9734/jammr/2021/v33i230807

Perpetual advances in the diagnostic tools, local plus systemic cancer treatments, and ensued lengthened survival times led to striking increments in the incidence rates of brain metastases (BMs), with a collective incidence range of 20-40% for all solid cancers. Stereotactic radiosurgery (SRS) and innovative molecularly targeted therapies are continuously gaining growing significance in the triumphant management of BMs, as the brain represents a sanctuary site for the vast majority of the conventional cytotoxic chemotherapies. In this scenario, the molecularly targeted agents appear to be an attractive alternative to traditional chemotherapeutics as they can modulate cancer metabolism and progression and exert synergism with radiation therapy. Therefore, the present paper intends to sum up the accessible proof on the consolidated utilization of SRS and molecularly targeted agents in the precise management of BMs from certain solid cancers, specifically the non-small-cell lung, breast, and renal-cell carcinomas, and malignant melanomas.