Alexandria Journal of Medicine

Using project-based learning to enhance curricular integration and relevance of basic medical sciences in pre-clerkship years

Fatma Alzahraa Abdelsalam Elkhamisy — 2023-09-19

Achieving high levels of integration in the basic medical sciences’ curricula is challenging. Project-based learning (PtBL) is an inquiry-based learning approach that can be used in multiple educational contexts with various designs. We used PtBL to enhance curricular integration during the pre-clerkship years. The study was done at The Faculty of Medicine, Helwan University, Cairo, Egypt. We designed interdisciplinary clinically relevant integrated research project tasks. Tasks followed curricular objectives. Students worked in teams to write and deliver project reports. Based on their understanding of the basic medical sciences, they analyzed the assigned tasks and used reasoning to create diagnoses. They related the condition to the disrupted normal structure/functions, suggested/contraindicated specific treatment and preventive plans. A cross-sectional survey was introduced to assess students’ perceptions of the learning approach used. Response rate was 52% (n = 694). Students’ responses were analyzed. Most students (84.6%) were satisfied by the integrated interdisciplinary PtBL. They (57.9%) preferred substituting the traditional lectures completely by it. Students understood the relation between objectives of disciplines after PtBL completion (mean 3.66, SD ±0.92) higher than before it (mean 3.46, SD ±0.91), (P = 0.000). Students’ ranking for the degree of integration between basic/clinical sciences in the PtBL was significantly associated with the developed clinical reasoning rank (P = 0.000). It was also associated with responses supporting the future implementation of the PtBL again (P = 0.002). Various ways of adding PtBL approach to the curricula were suggested. The PtBL can be used as a complementary learning method to elevate the level of integration within a multidisciplinary approach to boost students’ learning.

Confirmatory test versus screening test analyses for fetal mosaic variations; a large scale study

Seyed Akbar Moosavi — 2023-09-19

Background: Mosaic genetic anomaly is a problematic and interpretative issue in prenatal diagnosis. Conventional karyotyping, as a confirmatory test traditionally used for detecting mosaic and nonmosiac prenatal disorders. Recently Quantitative Fluorescence PCR (QF-PCR) is used for prenatal testing. We retrospectively assessed the frequency of both mosaic and nonmosaic conditions in a large-scale study and compared the clinical value of confirmatory cytogenetic analysis with QF-PCR and other screening tests.
Result: Of 6033 cases identified as abnormal conditions by sonography or protein marker screening tests, only 180 nonmosaic and 8 mosaic cases confirmed to be abnormal by confirmatory karyotyping test results. The cytogenetic analysis was correlated with other QFPCR confirmatory test results for nonmosiac conditions but it was not comparable for mosaic cases.
Conclusion: The cytogenetic analyses were shown to have the greatest clinical value in revealing the various mosaic conditions. The QF-PCR test is shown to be a reliable confirmatory test for nonmosaic diseases but not for mosaicism, and the screening protein marker test can weakly indicate the presence of abnormal cell lines. Moreover, older mothers (>30 years) are at greater risk for developing mosaic ova.

A step towards the application of an artificial intelligence model in the prediction of intradialytic complications

Ahmed Mustafa Elbasha — 2023-09-19

Introduction: Acute intradialytic complications remain a major burden in end stage renal disease (ESRD) patients on hemodialysis (HD). They often lead to early termination of the HD session affecting dialysis adequacy and patient overall health. The aim of the study was to create an artificial intelligence model and to assess its performance in the prediction of the occurrence of intradialytic clinical events.
Methods: We studied 6000 HD sessions performed for 215 ESRD patients, recording many predictors that included: patient, machine, and environmental factors. These data were collected within 24 weeks, including 12 weeks in the COVID 19 era and were used to develop and train an artificial neural network model (ANN) to predict the occurrence of intradialytic clinical events such as: hypotension, headache, hypertension, cramps, chest pain, nausea, vomiting, and dyspnea.
Findings: Our ANN model showed mean precision and recall of 96% and AUC of 99.3% in binary ANN to predict occurrence of an intradialytic complication (event or no event), while the accuracy of the categorical ANN in predicting the type of event was 82%. We found that heart rate changes, mean systolic pressure, ultrafiltration rate, dialyzate sodium, meal, urea reduction ratio, room humidity and dialysis session duration most strongly influence occurrence of an intradialytic complication.
Discussion: Our ANN model can be used to predict the risk of intradialytic clinical events among HD patients and can support decision-making for healthcare in the frequently understaffed dialysis units, especially in COVID 19 era.

Lung function abnormalities in patients with sickle cell disease in a Nigerian tertiary health centre

A.O. Odeyemi — 2023-09-19

Introduction: Pulmonary complications with the subsequent lung function abnormalities occur commonly among sickle cell disease (SCD) patients even while at their steady states. This study, therefore, aimed to determine the prevalence and pattern of lung function abnormalities and its associated factors among SCD patients.
Methods: This was a hospital-based cross-sectional study in a Nigerian tertiary hospital involving 113 SCD participants and age- and gender-matched non-SCD controls. Spirometry, transthoracic echocardiography, oxygen saturation, complete blood count, serum urea and creatinine were done for the participants.
Results: The forced vital capacity, forced expiratory volume in 1 second and the peak expiratory flow rate of the SCD participants were significantly lower than that of the control group with p-values of 0.004, 0.000 and 0.000 respectively. Of the SCD participants; 40.7% recorded abnormal lung function with the restrictive pattern occurring most commonly with a prevalence of 28.3%. There was a statistically significant relationship between age and lung function of the SCD participants (p = 0.044).
Conclusion: Lung function abnormalities occur frequently among people with SCD with the restrictive pattern being the most common abnormality and these abnormalities occur more frequently as these patients age.

Narrow band endoscopic diagnosis of portal hypertensive gastropathy in cirrhotic patients

Randa Salah Eldin Abdelmoneim Ibrahim — 2023-09-19

Background: Portal hypertensive gastropathy (PHG) is an overlooked complication of liver cirrhosis, as it is a source of acute upper gastrointestinal bleeding and cause of chronic blood loss.
Objective: To assess the role of narrow band endoscopy in the diagnosis of PHG in cirrhotic patients.
Methods: Fifty patients with liver cirrhosis were examined by both conventional White Light Endoscopy (WLE) and Narrow Band Technology Variable Intelligent Staining Technology (VIST) using Sonoscape endoscope HD500. Biopsies were taken from the body of gastric mucosa during endoscopy.
Results: The prevalence of PHG among patients with liver cirrhosis is around 94% by WLE, 92% by VIST, and 55.3% by pathology. There is no statistical significance between VIST and WLE in case of PHG p = 0,750. The risk of developing oesophageal varices grade 3 in severe PHG is higher than in no or mild PHG (OR = 6.8571, 95% CI 1.6270 to 28.9001, p = 0.0087).
Conclusion: VIST is comparable and complementary to WLE in diagnosis of PHG. There is poor correlation between pathology and WLE in diagnosis of PHG.

Utilization of long lasting insecticidal net among children aged less than five years in a tertiary health facility in south-west Nigeria

A.O Odeyemi — 2023-09-19

Introduction: Long-lasting insecticidal nets (LLINs) are the most widely used vector control interventions for preventing malaria transmission. The study sought to determine the regular use of LLIN, factors associated with the usage and the effect of regular LLIN utilization on the development of malaria among under-five children.
Methods: This was a hospital-based cross-sectional observation study. We enrolled consecutive caregivers with their children aged 6 to 59 months who presented with fever in the absence of a localizing sign. A structured questionnaire was used to obtain information about the level of utilization of LLIN. Malaria parasitemia was detected using the P. falciparum rapid diagnostic test kit and/or microscopic examination of blood.
Results: A total of 303 children/caregivers pair was studied. The mother’s mean (SD) age was 37.17 (6.75) years, while the children was 24.36 (16.63) months. The majority (183; 60.4%) of the children were male. Parental awareness of LLIN was high (96.7%), LLIN ownership was 72.3%, however, only 119 (39.3%) were regular user of LLIN. Factors significantly associated with regular LLIN use were younger age, parental awareness, ownership of LLIN, source of acquisition of LLIN and permanently hanging the LLIN on sleeping space (p = 0.031, 0.010, 0.000, 0.006 and 0.000 respectively). Using binary logistic regression, the child’s age, source of LLIN and hanging the LLIN permanently on the bed remained statistically significant to the regular use of LLIN (p = 0.046, 0.035 and 0.000 respectively).
The frequency of malaria was significantly higher among the children who did not use and those who uses LLIN irregularly (97.1% versus 32.9%, p = 0.000).
Conclusions: Regular use of LLIN is low in the study area. Hanging the insecticidal bed-net permanently on the bed/sleeping space promotes its regular usage. The frequency of malaria was reduced among the children using the LLIN regularly.

Growth trajectories in lipid profile and fasting blood sugar in prediabetic people over a 16- year follow-up and future risk of type2 diabetes mellitus: A latent growth modeling approach

Awat Feizi — 2023-09-19

Introduction: The current study aimed to investigate whether the pattern of changes in lipid profile and fasting blood sugar (FBS) can predict the future risk of type 2 diabetes mellitus (T2DM) incidence in prediabetic people.
Methods: In a prospective cohort study, 1228 prediabetic patients were followed from 2003 until 2019 and longitudinal data on lipid indices (CHOL: cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; TG: triglyceride) and fasting blood sugar (FBS) were recorded. The latent class growth model (LCGM) was used to estimate growth trajectories and to determine distinct subgroups (latent class) with a similar trajectory for lipid profile and FBS over time. The incidence of T2DM in extracted latent classes was compared.
Results: Finally, 946 people with complete data were included in statistical analysis. Two latent classes were identified based on the change in FBS including high-risk and low-risk classes (class size: 5.2% vs. 94.8%) with T2DM incidence rates 100% and 35.9%, respectively (P < 0.001). Two distinct subgroups were identified based on changes in lipid profile. Latent classes with abnormal TG, CHOL, HDL, and LDL included 18.8%, 21.8%, 38.8%, and 24% of study participants, respectively. The incidence rates of T2DM and remaining prediabetic in abnormal TG latent class were 57.2% and 30.8%, and in abnormal HDL latent class were 41.5% and 31.7% were significantly different from normal latent classes (P < 0.001). While in the extracted latent classes based on CHOL and LDL the incidence rates were not statistically significant differences (P > 0.05).
Conclusions: We identified two subgroups with high and low risk of future T2DM based on the changes in FBS and lipid profile by applying LCGM. The incidence of T2DM in extracted latent classes was significantly different. LCGM is a reliable approach for predicting the risk of T2DM incidence based on trajectories of risk factors.

Successful tuberculosis treatment outcome in East Gojjam zone, Ethiopia: cross-sectional study design

Maru Meseret Tadele — 2023-09-19

Introduction: Ill health is one of the natural phenomena that can happen to human beings at any time due to either communicable or non-communicable diseases. Tuberculosis (TB) is one of those communicable diseases caused by the bacillus Mycobacterium tuberculosis which can be transmitted through droplet nuclei while coughing, sneezing, shouting, or singing. Infection with tuberculosis negatively affects the productive segment of the economy, resulting in a reduction in national productivity. The World Health Organization (WHO) recommended early case detection, accurate diagnosis, and standardized treatment as a means to prevent new infections. In Ethiopia, detecting TB cases early, diagnosing, and treating these cases as per the guideline has been practiced for years through the Directly Observed Treatment Shortcourse (DOTS) program which was started in 1997. Various researches on TB treatment outcomes and their predictors have been done in Ethiopia. However, almost all of the findings vary from each other even though the country has a standardized definition of the outcomes and data aggregation tools. Moreover, none of the findings and reports showed the magnitude of successful TB treatment outcomes in the study area.
Objective: This research was intended to assess the prevalence of successful TB treatment outcomes among patients enrolled in a DOTS program in the east Gojjam zone, northwest Ethiopia.
Result: Eighty six percent (86%) of all cases enrolled in the DOTS program were successfully treated in the East Gojjam zone, and sex, place of residence, educational status, smear result during entry to the DOTS program, and HIV test result were factors significantly affecting successful TB treatment outcomes in the study area.
Conclusion and Recommendation: The magnitude of successful TB treatment outcome of this study is low compared to the national strategic plan. It is advisable to work on the identified factors to positively affect successful TB treatment outcomes in the study area.

Assessment and development of hospital emergency preparedness plan in response to COVID-19 pandemic in Alexandria University Hospitals

Eman Hamdy Basiony Darwisha — 2023-09-19

Background: The COVID-19 ongoing pandemic is one of the deadliest pandemics in history. It has put a significant strain on healthcare systems and frontline healthcare workers. This study attempted to assess and develop the emergency preparedness of hospitals affiliated to Alexandria University.
Methods: A quasi-Aquasi-experimental design was conducted in three phases; the pre-intervention assessment using ahospital emergency response checklist, then awareness intervention was implemented to provide information on emergency preparedness followed by post-intervention assessment after asix-month period following the first phase using the same checklist.
Results: The pre-intervention assessment showed that four hospitals had a good overall preparedness level (75% or more preparedness level), while the rest of the hospitals (7 hospitals) demonstrated a fair overall preparedness level (50%- <75%). All the individual domains have demonstrated a good or fair to good preparedness levels except the recovery domain, which was fair, and the command and control domain, which was poor in the majority of the studied hospitals. The intervention awareness program has led to a significant statistical change in the command and control as well as human resources domain. However, the post-intervention scores of command and control domain remained poor in the majority of the studied hospitals.

Treatment of giant cell tumor of bone using bone grafting and cementation with versus without gel foam

Ahmed AlaaElDin Ibrahim ElDesouqi — 2023-09-19

Background: Giant cell tumor (GCT) of bone is a benign locally aggressive tumor that constitutes 20% of the body's benign bone tumors. Most of the GCTs exhibit a typical epiphyseal location that shows a tendency for significant bone destruction and local recurrence. We aimed to assess the functional and oncological outcomes of GCT patients treated with bone grafting and cementation with or without gel foam.
Materials and methods: This prospective study included 40 patients presented at El Hadara University Hospital with GCT of bone around the knee from January 2017 to January 2022 treated by bone graft and cementation. Twenty cases were treated with gel foam (Group I) and 20 cases were treated without gel foam (Group II) through random allocation without selection. Recurrence was assessed as progressive lysis of 5 mm at the bone cement interface. Functional outcomes were assessed using the musculoskeletal tumor society score (MSTS) after a period of minimum 30 months.
Results: In Group I, 18 patients (90%) had excellent results (range 24 and 30) according to MSTS and two patients (10%) had good results (range 18 and 23), while in Group II, 16 patients (80%) had excellent results and four patients (20%) had good results. No patients were graded as having fair or poor results. Twenty patients (100%) had satisfactory results, and no patients (0%) had unsatisfactory results. The overall recurrence rate was about 15%.
Conclusion: Reconstruction of GCT of bone with sandwich technique offers good option as joint preserving surgery. Most of the patients get benefit in terms of better quality of life and good function regardless of age and gender. Subchondral bone grafting reduces the effect of heat on articular cartilage, but longer follow-up is required. There is no benefit of gel foam addition in terms of function or oncological outcome.

Abdominal volume index is a better predictor of visceral fat in patients with type 2 diabetes: a cross-sectional study in Ho municipality, Ghana

Sylvester Yao Lokpo — 2023-09-19

Background: Visceral obesity is associated with increased risk of metabolic disorders and cardiovascular disease, hence, diagnosing visceral fat is indispensable in clinical practice. However, the diagnostic capacity of waist–hip ratio (WHR), conicity index (CI), and abdominal volume index (AVI) to predict visceral obesity in patients with type 2 diabetes remains unclear. This study was designed to evaluate the performance of WHR, CI, and AVI in predicting visceral fat among patients with type 2 diabetes in Ho municipality.
Methods: A hospital-based cross-sectional survey involved 221 patients with type 2 diabetes. A questionnaire was designed to collect data on demography and other relevant variables. Anthropometric measurements were obtained using standard methods. Visceral fat was measured using bioelectrical impedance analysis (BIA). The diagnostic performance of WHR, CI, and AVI in predicting visceral fat was evaluated based on receiver operating characteristics (ROC) curve analyses. Pearson correlation analysis was used to determine the relationship between adiposity indices and visceral fat.
Results: Among men, the optimal threshold for AVI, >15.56, demonstrated the highest sensitivity, 87.5% and specificity, 80.71% compared to CI and WHR while among women, the optimal cutoff value for AVI, >18.49, produced the highest sensitivity, 77.05% and specificity, 85.29%. Likewise, AVI showed a better discriminatory ability in the diagnosis of visceral fat (AUC: 0.89; p < 0.001) compared to CI (AUC: 0.68; p < 0.003), and WHR (AUC: 0.73; p < 0.001) in men and AUC: 0.89; p < 0.001 compared to CI (AUC: 0.62; p < 0.023), and WHR (AUC: 0.59; p < 0.066) in women. Similarly, the strongest positive correlation was observed between visceral fat and AVI after adjustment for age (male r = 0.787, p < 0.01; female r = 0.770, p < 0.01).
Conclusion: AVI appeared to have outperformed CI and WHR in the diagnosis of visceral fat. Therefore, it could be a better predictive tool for visceral obesity among patients with type 2 diabetes in low-resource settings.

Immunohistochemical expression of CD8, CTLA4, and PD-L1 in NSCLC of smokers versus non smokers and its effect on prognosis

Rasha. O. Elsaka — 2023-09-19

Background: Identifying hig- risk non-small cell lung cancer (NSCLC) patients is the most contentious area in lung pathology for reducing cancer-related morbidity and mortality.
Aim of the work: Was to investigate the immunohistochemical expression of CD8, CTLA4, and PD-L1 among different NSCLC histopathological variants and it’s correlation with different clinicopathological variables.
Material and Methods: Expression of CD8, CTLA4, & PD-L1 was evaluated immunohistochemically in 45 NSCLC cases.
Results: Higher expression of CD8 tumor infiltrating lymphocytes (TILs) was significantly associated with better progression-free survival (PFS). The expression of CTLA4&PD-L1 on tumor cells was significantly associated with lower PFS. However, smoking status of the studied cases showed no statistically significant correlation with expression of any of the studied immunohistochemical markers.
Conclusions: Immunostaining for CD8, CTLA4, and PD-L1 could have a major role in the anticipation of PFS of NSCLC cases regardless of their smoking status.

Evaluation of anthropometric profile in obese children: risk factors & eating disorder

rym Ben Othman — 2023-09-19

Background: Nutrition is the most important environmental factor in the development and progression of childhood obesity, which is very common in Arabic countries.
Aim: Study of associated factors and nutritional status of childhood obesity.
Methods: This was a comparative study of 50 obese children recruited from the outpatient department of the children’s hospital, as well as 35 controls. The two groups were matched for gender and age. Anthropometric measurements have been undertaken. A food history as well as a frequency of consumption of certain foods were performed.
Results: There were 32 girls in obese group. Breastfeeding was more common in the control group (p = 0.04) but gestational diabetes, pregnancy weight gain, and macrosomia were greater in obese people (p = 0.002; 0.0001 and 0.004) . Food diversification was early in the obese (p = 0.05). Mobile phone use was higher among obese people (p = 0.001) but time spent watching TV was not significant (p = 0.06). There was no significant difference between the two groups regarding: the number of hours of sleep, and the practice of sport. Sedentary lifestyle concerned 34% of obese versus 8.57% controls. Intense physical activity was practiced by 14.29% of the controls against any obese (p = 0.0001). The anthropometric parameters of the parents of the obese were more important than those of the controls. The average BMI of the obese was 25.63 Kg/m2.The frequency of consumption showed a more caloric and fat diet in obese group.The diet of the controls was richer in proteins and lipids but better distributed in MUFA and PUFA, but the energy intake of the obese was significantly higher (10,612 versus 4097 Kcal/d). The mineral and vitamin intakes of the obese were correct.
Conclusions: The fight against childhood obesity essentially involves prevention and promotion of a good lifestyle.

Mechanistic role of epigallocatechin-3-gallate in regulation of the antioxidant markers in ethanol induced liver damage in mice

Mujinya Pastori — 2023-09-19

Background: Failure of endogenous antioxidant system to eliminate high levels of ROS results to oxidative stress, consequently leading to liver damage. Excessive alcohol consumption leads to liver damage due to ROS generation, thus regarded as the leading causes of death worldwide, suggesting great need for use of exogenous antioxidants like epigallocatechin-3-gallate (EGCG), to avert liver damage. However, underlying EGCG mechanisms remains elusive.
Aim of the work: This study focused on mechanistic role of EGCG in regulation of antioxidant marker activities during ethanol induced liver damage.
Materials and Methods: 20 male Swiss Albino mice were divided into four groups and treated with different dosage. ALT, AST and total proteins were determined as indicators of liver damage. MDA and protein carbonyls were measured as oxidative stress markers. Activities of SOD and CAT were determined. SOD-2 and CAT differential gene expression were also determined. Liver histology analysis by H&E staining. All the experiments were run in duplicates. ANOVA was used to analyzes data using Tukey’s multiple comparison tests and results considered statistically significant if p ≤ 0.05 at 95% confidence level.
Results: Findings revealed that chronic consumption of ethanol leads to liver damage through increased levels of serum ALT and AST, MDA, protein carbonyls and remarkable diffuse lipid droplets and decreased enzyme activity of SOD and CAT. EGCG increased activity of SOD and CAT and SOD-2 expression and did not affect CAT expression.
Conclusion: In summary, ethanol induces liver damage, and administration of EGCG increases antioxidant system expression, suggesting its role in regulating their activities, defensive of oxidative stress through various pathways.

Nonalcoholic fatty liver disease is associated with early left ventricular diastolic dysfunction in patients with type 2 diabeteS

Walaa Sheba — 2023-09-19

Background: Left ventricular diastolic dysfunction (LVDD) is the first preclinical sign of diabetic cardiomyopathy. Nonalcoholic fatty liver disease (NAFLD) is linked to morbidity and mortality in Type 2 diabetes mellitus (T2DM) and increases the chance of developing cardiovascular disease, the primary cause of death.
Aim: This work aimed to identify the association of LVDD and NAFLD in T2DM.
Methods: We recruited 40 patients with T2DM (20 with NAFLD and 20 without NAFLD). Laboratory investigations and abdominal ultrasonography were carried out. The degree of hepatic steatosis was measured by the hepatorenal index (HRI). The LVDD was assessed by echocardiography and tissue doppler imaging.
Results: The Left atrial volume, left ventricular volume index, and left ventricle filling pressure index (E/é) were higher in the NAFLD group (P < 0.05). The E/é index was correlated with HRI and gamma-glutamyl transpeptidase (P < 0.05). Hepatic steatosis by HRI was the only independent variable associated with LVDD.
Conclusion: NAFLD is associated and correlated with an increased risk of left ventricular diastolic dysfunction in patients with T2DM regardless of ventricular systolic function.

Ocular abnormalities among patients with Down syndrome

Khalid Awad — 2023-09-19

Introduction: Ocular abnormalities among down syndrome (DS) patients are a sensitive issue since the DS patients is a minor group in the general population.
Objectives: This study determined the prevalence of visual acuity, refractive errors, and ocular diseases among the DS patients; analyzed the association between refractive errors and (age, gender, visual acuity, and type of squint); and compared the results with similar studies in other countries.
Methods: Clinical examination of the eye included visual assessment with cyloplegic refraction and ocular motility. The visual acuity was evaluated according to the patient’s intelligence and responsiveness. The sample size was 50 children. All members of the Palestinian Association of DS patients were subject to ocular investigation after giving consent form from the parents.
Results: Results showed that 27 boys and 23 girls in the age range of 10–16 years were suffering from DS. The majority of visual acuity was 6/60 (22%) and minority was 6/6 (8%). Astigmatism (40%) was the highest ocular abnormality followed by hyperopia (36%), whereas the low prevalence was with myopia (14%) among both genders.
Conclusion: The study revealed the association between age and hyperopia and astigmatism. These results suggest the influence of environmental quality. This study recommends investigating the influence of environmental quality in the ocular abnormalities in DS and general population.