Open Access Minireview Article

Outcome of Free Medial Sural Artery Perforator Flap (MSAP) for Head and Neck Reconstruction: A Systematic Review and Met Analysis

M. M. Hosain

Journal of Advances in Medicine and Medical Research, Page 11-20
DOI: 10.9734/jammr/2021/v33i330816

Introduction: Since first described by Cadavas, A free medial sural artery perforator flap (MSAP) is getting popularity day by day. Specially, where the micro surgeons are desired to have thin, pliable flap with long pedicle and less donor site morbidities. For its above-mentioned characteristics and good outcome, it is now considered as one of the workhorse flaps for head and neck reconstruction.

Aims and Objectives: The aim was to find out the feasibilities and versatilities of this flap as workhorse in head and neck reconstruction. As well as taking into consideration of its low donor site morbidities.

Methods: A literature search has been performed in July 2020 in various data base including Pub Med, Trip database, Medline and Google Scholler to find out the outcome of head and neck reconstruction with free MSAP Flap. Data then were tabulated and analysed using Microsoft Excel datasheet.

Results: The results were promising. Overall, flap survival rate was 95%. Mean flap dimension was 9.3 cm x5.5 cm. Average pedicle length was 10.5 cm. Mean flap thickness was 6mm. Overall complication rate was 16% including 6% wound related and 2% donor site complication. Most of the cases donor site have closed directly (87%).

Conclusion: Free MSAP Flap is an ideal workhorse flap for head and neck reconstruction. However, as most of the literatures were case series or personal experiences of surgeons, a multicentre trial with large sample can give us more information.

Open Access Original Research Article

Evaluation of Local Corticosteroids Injection in Treatment of Carpal Tunnel Syndrome

Mostafa Fersan Sallam, Nabil Omar Gharbo, Muhammed Abd Elmoneam Quolquela, Mohammed Osama Ramadan

Journal of Advances in Medicine and Medical Research, Page 21-27
DOI: 10.9734/jammr/2021/v33i330817

Background: Carpal tunnel syndrome is the most common type of peripheral nerve entrapment; it affects females more than males; it may be idiopathic or secondary to other disorders especially diabetes mellitus. Carpal tunnel syndrome mostly affects manual workers and may be bilateral or unilateral and mainly affects the dominant hand. Carpal tunnel syndrome has characteristic symptoms and signs including paresthesia and pain along median nerve distribution, these symptoms are usually accompanied by positive provocative tests. Electrodiagnostic studies remain the cornerstone in the diagnosis of CTS. Carpal tunnel syndrome can be treated conservatively by activities of daily living instructions, splints, medical treatments as neurotropic drugs and NSAIDs and local steroid injection. Also, it can be treated by surgical decompression in severe cases.

Aims: The aim of this study was to evaluate local steroid injection in the treatment of CTS. Twenty-one patients with mild and moderate CTS were included in this study.

Patients and Methods: This was a prospective study included 21 patients with symptoms and signs of mild to moderate CTS attending the outpatient clinic of orthopedic Department, Tanta University Hospitals in the period between February 2019- January 2020. 1 ml Triamcinolone was used with 2 ml lidocaine. Patient’ hand was rested on towel roll flexed about 30 to 45 degrees and injection was done according to landmarks. Night splint was described for 3 days after injection.

Results: In regards to clinical assessment; there was a significant clinical improvement after injection and follow-up period as compared to before injection. In regards to electrophysiological assessment; there was a significant improvement in NCS after injection.

Conclusion: Local steroid injection is an effective treatment and recommended as a therapeutic tool in the management of idiopathic mild to moderate CTS.

Open Access Original Research Article

An Up to Date Guideline for Management and Prevention of Dog and Cat Bite – A Literature Review

M. M. Hosain, M. T. Mohamed, A. Siddiqui

Journal of Advances in Medicine and Medical Research, Page 28-38
DOI: 10.9734/jammr/2021/v33i330818

Background: The prevalence of animal bites is high, of which the vast majority are from cats’ and dogs’. There is a wide variation in severity of such bites from mild to lethal. The evidence in the literature with respect to management does not provide a solid ground on which such cases could be managed. Dog and Cat bites are more common and can have dramatic consequences especially for children.

Objective: This project is to identify current evidence in the literature on epidemiology, management and prevention of dog and cat bites. This review is aimed at clinicians who deal with dog and cat bites. The basic principles of wound management and indications for use of antimicrobials, tetanus and rabies prophylaxis as well as preventive education are the primary focus of this article to help the clinicians. This aims at updating the management of patients who sustain a dog or a cat bite.

Materials and Methods: A literature review on the management of animal bites was performed. UK NICE guidelines, University of Texas bites management guidelines, WHO rabies prophylaxis protocol, UK Green Book and infectious diseases text books also reviewed.

Results: The available data in the literature suggest that appropriate wound management is the most important factor for prevention of infection in dog and cat bites. Antibiotic prophylaxis should only be given in high-risk wounds and primary closure should be performed in low-risk wounds.

Conclusions: Proper assessment and wound care are the prime consideration for dog and cat bites management.

Open Access Original Research Article

Phytochemical Evaluation and Anti-Diabetic Effects of Ethanolic Leaf Extract of Petersianthus macrocarpus on Streptozotocin-Induced Diabetic Rats

Aligwekwe A. Ugochukwu, Idaguko C. Anna

Journal of Advances in Medicine and Medical Research, Page 39-47
DOI: 10.9734/jammr/2021/v33i330819

Aim: The purpose of this study was to evaluate the antidiabetic effect of ethanolic extracts of Petersianthus macrocarpus leaf and its phytochemical analysis using different solvents.

Place and Duration of Study: The study was carried out between March and September in 2018 in the Department of Anatomy, Madonna University, Elele. River State, Nigeria.

Materials and Methods: Twenty five Wistar rats, weighing between 200-225g were divided into five groups of five rats.  Group A (Control) while Groups B, C, D and E were induced with diabetes using streptozotocin firstly 35mg/kg b.w; and 2 weeks later 25mg/kg b.w.  Group B (Diabetic control), Group C received 0.5mg/kg b.w of Glibenclamide. Groups D and E received daily 50 and 100 mg/kg b.w of ethanolic leaf extract of P. macrocarpus orally for two weeks. The fasting blood glucose levels were determined weekly for two weeks. At the end of the experiment, the animals were sacrificed and the pancreas was removed for histological procedures.

Results: The body weights increased significantly (P<0.05) in 100 mg/kg b.w group when compared to the diabetic control rats weight at the end of the experiment. Also there was a significantly decreased (P<0.05) in blood glucose levels in P. macrocarpus (100mg/kg b.w). The histological section of the pancreas of diabetic control showed eosinophilic material in the islet, shrinkage of the islet of Langerhans while the group treated with 100 mg/kg of extract showed granulated and well prominent pancreatic islet of Langerhans. Phytochemical screening showed methanolic extract of P. macrocarpus leaf having alkaloid, saponin, tannin, phenol, flavonoid, cardiac glycoside, steroids, terpenoids, anthocyanin and anthraquinone. However, cardiac glycosides and steroids were absent in ethanolic extract. Cardiac glycoside and terpenoids were also absent in hexane and acetone extract, while phenol, cardiac glycosides, steroids and anthrocyanin were absent in the water extract.

Conclusion: Ethanolic leaf extract of P. macrocarpus ameliorate streptozotocin-induced diabetes in Wistar rats.

Open Access Original Research Article

Fear, Psychosomatic Symptoms and Satisfaction of Primary Healthcare Workers during the First Wave of COVID-19 Pandemic in Rivers State Nigeria: A Descriptive Cross-sectional Study

Clement Kevin Edet, Agiriye M. Harry, Anthony Ike Wegbom, Benjamin O. Osaro

Journal of Advances in Medicine and Medical Research, Page 48-54
DOI: 10.9734/jammr/2021/v33i330820

Introduction: Since the onset of COVID-19 pandemic there has been concerns about the imminent collapse of the health system if healthcare workers are physically, mentally, and socially affected to the point where service delivery is compromised. Therefore, this study investigated the fear, psychosomatic symptoms, and satisfaction of the Primary Healthcare Workers (PHCWs) during the first wave of the COVID-19 pandemic in Rivers State Nigeria.

Methods: A facility cross-sectional survey was conducted involving the primary healthcare workers. Descriptive analysis of mean with standard deviation were reported for continuous variables, frequency and percentage were used to report categorical variables.

Results: A total of 412 PHCWs participated in the study (mean age: 39.5±7.5). 223 (54.4%) were sure of going to work, while 260 (63.4%) were afraid of contracting the COVID-19 virus. However, 294 (71.7%) were not stigmatized and 256 (62.4%) were satisfied with their capacity for work. Also, 333 (81.2%), 357(87.3%), and 271(66.6%) were not satisfied with, transportation, money to meet their daily needs, and work environment, respectively. Perceived psychosomatic symptoms by respondents were chest pain (50.0%), stomach upset (38.0%), lump in the throat (40.0%), no feeling of hunger (52.0%), and shortness of breath (32.0%). Anxiety and stress symptoms experienced were inability to concentrate (38.2%), got angry easily (24.9%), worried (48.5%), low mood, anxiety, or depression (24.1%) and afraid of encountering security personnel on their way to work (67.6%).

Conclusions: We observed perceived fears, psychosomatic, anxiety, and stress symptoms, as well as low satisfaction among the primary healthcare workers. We suggest that the government and health care agencies should put in place measures that will improve the psychological well-being and mental health of the PHCWs during the pandemic.

Open Access Original Research Article

Immature Platelet Fraction as a Non-Invasive Marker for Esophageal Varices

Alyaa Marzouk Soliman, Sherief Mohamed Abd-Elsalam, Amal Saeid ALBendary, Osama El. Sayed Negm

Journal of Advances in Medicine and Medical Research, Page 55-64
DOI: 10.9734/jammr/2021/v33i330821

Background: All cirrhotic patients should be screened for oesophageal varices (OV) at the time of diagnosis. The development of a non-invasive method for the detection of OV is a vital issue in subjects with cirrhosis to decrease the need for invasive endoscopic procedures that can be costly. This work aimed to evaluate immature platelet fraction (IPF) as a non-invasive marker and predictor of OV.

Methods: This cross-sectional study was carried out on 80 cirrhotic patients with esophageal varices diagnosed by upper endoscopy. They were divided into Group (1): 40 patients with cirrhosis with esophageal varices and Group (2): 40 patients with cirrhosis and without esophageal varices. All patients were subjected to the complete history taking, physical examination, routine laboratory investigations (Complete blood count, IPF, C-reactive protein, Liver and kidney function tests, Bone marrow aspiration for some cases, Ascetic sample analysis when applicable), Pelvic-Abdominal ultrasonography, Child Pugh score assessment, Upper GIT endoscopy.

Results: There was a significant difference between the studied groups regarding IPF (p<0.001). At cutoff >12 IPF had (AUC= 0.993) with sensitivity of 97.5% and specificity of 97.5% for detection of esophageal varices. There was a significant negative correlation between IPF and platelets count (p- value < 0.001). There was a significant positive correlation between IPF and Child Pugh score (p- value <0.001). There was a highly significant positive correlation between IPF and CRP (p value <0.001). There was significant difference between the two groups as regards splenic longitudinal diameter (p<0.001). As regards platelet count, there was a significant difference between the two groups (p<0.001). It was significantly lower in Group 1.

Conclusions: IPF is elevated in cirrhotic patients with naive esophageal varices than in cirrhotic patients without varices. IPF could be used as a noninvasive, easy to measure method for detection of the presence of esophageal varices at a cutoff level of >12.

Open Access Original Research Article

Effect of Curcumin, Exelon and their Combination on Brain in Alzheimer’s Disease-Induced Rats

Mohy Eldin Abd EL-Fattah Abdel-Atty, Waleed Fathi Khalil, Shahinda Mahmoud Mohamed

Journal of Advances in Medicine and Medical Research, Page 65-78
DOI: 10.9734/jammr/2021/v33i330822

Because of the continues rising in the number of patients who have Alzheimer’s disease (AD) throughout the twenty-first century, the looking for remedies increase by scientists. The treatment of AD remains a challenge due to an incomplete understanding of' reasons that lead to the selective neurodegeneration typical of Alzheimer’s brains. Among treatment for AD, the renewed interest in curcumin is rise for its potential medication. As kind of natural product curcumin with anti-AD properties is very important for prevention and treatment. The aim of the present study was evaluated the activity of curcumin in the recession of AD induced in adult male albino rats. The results showed that treatment of AD groups with curcumin or rivastigmine experienced significant decreased in brain AChE, Aβ (1-42), and MAD levels with respect to untreated group associated with significant increase in brain GSH, SOD, and CAT. activity. Further showed combination of curcumin with rivastigmine was more efficacious in treatment of AD as compared to their effect alone.

Open Access Original Research Article

Detection of Unspecified Inflammatory Bowel Disease, Crohn’s Disease and Ulcerative Colitis via Metabolite Analysis and Machine Learning

Elliot Kim, Valentina L. Kouznetsova, Igor F. Tsigelny

Journal of Advances in Medicine and Medical Research, Page 79-104
DOI: 10.9734/jammr/2021/v33i330823

The current standard of inflammatory bowel disease (IBD), especially, Crohn’s disease (CD), diagnosis is set through an invasive endoscopy procedure. However, serum metabolites hold potential as useful biomarkers for non-invasive diagnosis and treatment of IBDs. The goal of this research was to elucidate the biomarkers including metabolites and genes related to IBDs, to show their distinguishing and common features, and to create a machine-learning (ML) model for recognition of each disease. We explored metabolic pathways and gene–metabolite networks related to unspecified-IBD (uIBD), Crohn’s diseaseand ulcerative colitis (UC). P38 MAPK, ERK1/2, AMPK, and proinsulin were found to be closely related to the pathology of IBDs. The best performing ML model, trained on filtered disease-specific metabolite datasets, was able to predict metabolite class with 92.17% accuracy. Through examination of IBD-related serum, significant relationships between the inputted metabolites and certain metabolic and signaling pathways were found, which can be pinpointed and used to increase accuracy of disease diagnoses. Development of a ML model including metabolites and their chemical descriptors made it possible to achieve considerable accuracy of prediction of the IBDs. Our results elucidate a large variety of metabolites, genes, and pathways that could be used for better understanding of IBDs’ molecular mechanisms.

Open Access Original Research Article

Study of Cardiovascular Diseases Risk in Systemic Lupus Erythematosus Can Be Comparable with Type 2 Diabetes Mellitus

Reham M. Abdalla, Abdallah A. Elsawy, Mohamed H. Alshafi, Abdelmoteleb T. Eissa

Journal of Advances in Medicine and Medical Research, Page 105-114
DOI: 10.9734/jammr/2021/v33i330824

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease. Cardiovascular manifestations are common in SLE, which may have a wide range of severity and one of the major causes of morbidity and mortality. Diabetes mellitus (DM) is one of the most common metabolic diseases. One of the major risk factor for cardiovascular diseases is DM, which is the most common cause of death among diabetic patients.

Aim of the Work:  evaluation of subclinical atherosclerosis as a predictor for CVD in patients with SLE and DM.

Methods: 50 SLE patients, 50 T2DM patients, 50 diabetic SLE patients and 50 healthy controlled subjects were enrolled in this study. They were undergone to Doppler examination of the extra-cranial portion of the carotid and femoral arteries measuring the intima-media thickness.

Result: In SLE the subclinical atherosclerosis was present in 22% of patients and was significantly associated with older age (p˂0,001), high blood pressure (p=0,023), overweight (p=0,004), proteinuria (p˂0,001), total cholesterol (p=0,004), active disease (p=0,007), high SLEDAI score (p˂0,001) and long duration of SLE (p˂0,001); whereas in diabetic patients the subclinical atherosclerosis was documented in 24% and was significantly associated with older age (p˂0,001), overweight (p˂0,001), proteinuria (p˂0,001), low hemoglobin (p=0,041), total cholesterol (p=0,001), LDL (p˂0,001), uncontrolled diabetes (p=0,005) and long duration of diabetes (p=0,001) but in SLE diabetic patients the subclinical atherosclerosis was documented in 44% of patients.

Conclusion: Subclinical atherosclerosis is frequent in patients with SLE and increases with increased disease activity. Subclinical atherosclerosis in SLE diabetic patients was significantly more than that in SLE or diabetic patients.

Open Access Original Research Article

Infertility and Its Associated Factors among Women Attending Selected Health Facilities in Boripe Local Government Osun State

Abayomi Olarinmoye, Olayinka Ajao, Olanrewaju Davies Eniade, Chinonso Esther Ekwonwa, Yusuff Akinkunmi Olasunkanmi, Ugushida Ogenma

Journal of Advances in Medicine and Medical Research, Page 145-152
DOI: 10.9734/jammr/2021/v33i330827

The extent to which women of reproductive age (15-49 years) experience infertility have not been fully explored in developing countries including Nigeria. Assessing the factors associated with infertility among infertile women can inform interventions to support their needs. This study was conducted to investigate the risk-factors of infertility among women in Boripe local government area (BLGA) of Osun State.

A matched case-control study was conducted among infertile women attending the infertility clinic and fertile women attending ante-natal clinic in three health facilities namely: Ada health facility, Isale Oyo health facility and MDGs Oloti health facility in Boripe local government area in Osun state, Nigeria. Cases (n=135) were gotten from the infertility clinic across the three study facilities and controls (n=135) were the pregnant women attending the antenatal clinic in the three health facilities.

Mean age was 29 ± 6.7 years, ranging from 16 to 47 years. Higher proportion of the infertile women (72.6%) had primary infertility, and a lot (35.9%) were not on treatment. Associated factors were partners’ age (p=0.007), income (p=0.067), age at menstrual debut (p=0.049), mental wellbeing (p=0.006). Factors associated with the likelihood of infertility were age at menstrual debut (>=15 years) (OR: 2.69, 95%CI: 1.07-6.75) in relative to age at menstrual debut (< 15 years).

This study revealed a high prevalence of primary infertility, income, dietary habit and age at menstrual debut were associated with the likelihood of infertility. Much attention towards improving knowledge about factors influencing infertility such as dietary habit and early treatment for teenagers who have late menstrual debut will be helpful in reducing burden of infertility. Also, this study revealed that majority of the infertile women was not on treatments. This suggests that, it is likely that most of them were not seeing a pregnancy counselor. The role of pregnancy counseling on infertility should be appropriately explored in further studies.

Open Access Review Article

Pharmacotherapy for Patients with Chronic Kidney Disease during the COVID-19: A Narrative Review

Mansour Adam Mahmoud

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2021/v33i330815

Background: COVID-19 is considered the most challenging global pandemic. Patients with COVID-19 are more vulnerable to renal impairment especially those admitted to the Intensive Care Units (ICUs).

Objective: In this review we discuss the epidemiology, the pathophysiology, the clinical implications and specific COVID-19 therapy in CKD patients.

Results: The prevalence of CKD patients with COVID-19 varies between 0.7 to 47.6%. Patients with CKD ought to be encouraged to take extra precautions (isolation, distancing, wearing Personal Protective Equipment (PPE)) to limit the risk of exposure to the virus. Renin-Angiotensin System (RAS) and SARS-CoV-2 interactions, through the binding of the virus to ACE-2, have  produced speculations of both likely damage and advantage of RAS inhibitor use during the pandemic. Remidisivir should be avoided in CKD patients (Cr Cl<30ml/min) with COVID-19. In addition, the doses of nephrotoxic medications (chloroquine phosphate and dexamethasone) that are recommended to be used in the management of COVID-19 should be adjusted according to creatinine clearance and dialysis.

Conclusion: COVID-19 may worsen the impaired kidney function and increase mortality.                Care givers should pay especial attention to medications dosing in COVID-19 patient with CKD history.

Open Access Review Article

Disseminated Histoplasmosis; A Threat in Advanced HIV Disease Population in Sub-Saharan Africa?

Christine E. Mandengue, Bassey Ewa Ekeng, Rita O. Oladele

Journal of Advances in Medicine and Medical Research, Page 115-144
DOI: 10.9734/jammr/2021/v33i330825

Background: Histoplasmosis is a neglected acquired immune deficiency syndrome (AIDS)-defining disease in sub-Saharan African countries, which is commonly misdiagnosed as tuberculosis (TB) due to similar imagery and clinical features; patients usually receive presumptive anti-TB treatment that is considered as anti-TB treatment failure. Patients with advanced human immunodeficiency virus (HIV) disease (AHD), CD4<200/mm3 or World Health Organisation clinical stage 3 or 4, develop disseminated histoplasmosis (DH) diagnosed at a late stage or at post-mortem, owing to poor clinical suspicion, lack of rapid diagnosis tools to offer rapid and accurate results, and non-availability and accessibility of appropriate antifungal medications. We report 31 cases of DH amongst patients with AHD in sub-Saharan African population from the literature, highlighting the challenging care issue in sub-Saharan Africa.

Results: Out of 31 reported cases 64.51% (20/31) were caused by Histoplasma capsulatum var capsulatum, 48.38% (15/31) being immigrants in Europe, Canada and Japan, with 41.93% (13/31) mortality, and 6 cases having no reported outcome. The poor index of suspicion on the part of clinicians; the lack of skilled laboratory personnel and rapid and accurate diagnosis tools of histoplasmosis for a proper detection of either classical or African histoplasmosis coexisting in many sub-Saharan African countries; and the non-availability and accessibility of appropriate antifungal medications were the most challenges in caring DH in advanced HIV disease population in sub-Saharan Africa.

Conclusion: there is a need for prompt and routine screening of advanced HIV disease patients in sub-Saharan Africa for histoplasmosis as an AIDS-defining illness.