IJMMS | Table of Contents

Table of Contents 2023

International Journal of Medicine and Medical Sciences | Vol. 13, No. 9, September 2023 | pp. 65–72

DOI: 10.46882/2023/IJMMS/130065

Original Research Article

A Retrospective Assessment of Surgical Site Infection Trends and Microbiological Profiles following Elective Cholecystectomy

Blessing N. Chukwu¹, Patrick E. Lawson², Evelyn M. Kamau¹*

¹Department of Surgery, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria.

²Department of Community Health, College of Health Sciences, Moi University, Eldoret, Kenya.

Abstract:

Surgical site infections (SSIs) complicate elective gastrointestinal surgeries, increasing healthcare costs and delaying recovery. This retrospective clinical study analyzed the five-year trend (2018–2022) and specific microbiological patterns of SSIs following elective open and laparoscopic cholecystectomy procedures at a regional referral hospital. We extracted data from 850 patient files meeting standard exclusion and inclusion criteria. Post-operative wound infections were identified and classified using the Centers for Disease Control and Prevention (CDC) definitions. Out of 850 cholecystectomies performed, 42 cases of SSIs were confirmed, representing an overall incidence rate of 4.94%. The incidence was significantly higher in open cholecystectomies (7.2%) compared to laparoscopic approaches (2.1%, p < 0.01). Microbiological characterization of wound swabs showed that Escherichia coli was the most common pathogen (38.1%), followed by Klebsiella pneumoniae (23.8%), Pseudomonas aeruginosa (16.7%), and Staphylococcus aureus (14.3%). Antibiogram mapping revealed high resistance rates among Gram-negative isolates to cefuroxime (72.4%) and amoxicillin-clavulanic acid (65.5%), while excellent susceptibility profiles were maintained for piperacillin-tazobactam (91.4%) and amikacin (94.8%). Logistic regression demonstrated that an operative duration > 120 minutes (OR = 2.9, 95% CI = 1.4–5.8, p < 0.01) and conversion from laparoscopic to open surgery (OR = 3.4, p < 0.01) were independent risk factors for SSI. Laparoscopic cholecystectomy significantly reduces the risk of post-operative wound infections. The high resistance to common cephalosporins highlights the need to update perioperative antibiotic prophylaxis guidelines based on local susceptibility patterns.

Keywords: Surgical Site Infection, Cholecystectomy, Laparoscopy, Escherichia coli, Antibiotic Resistance, Perioperative Prophylaxis

Manuscript Timeline: Received: June 11, 2023; Revised: July 20, 2023; Accepted: August 14, 2023; Published: September 15, 2023.

Citation: Chukwu BN, Lawson PE, Kamau EM. A Retrospective Assessment of Surgical Site Infection Trends and Microbiological Profiles following Elective Cholecystectomy. International Journal of Medicine and Medical Sciences, 2023, 13(9): 65–72. DOI: 10.46882/2023/IJMMS/130065

[Read More]

International Journal of Medicine and Medical Sciences | Vol. 13, No. 8, August 2023 | pp. 57–64

DOI: 10.46882/2023/IJMMS/130057

Original Research Article

Evaluation of Viscoelastic Coagulation Parameters using Thromboelastography to Predict Thrombotic Events in Post-Operative Onconcology Patients

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Surgical oncological interventions trigger an acute hypercoagulable state, increasing the risk of venous thromboembolism (VTE). This prospective cohort study evaluated the performance of Thromboelastography (TEG) compared to conventional coagulation assays (CCA) for predicting post-operative deep vein thrombosis (DVT) and pulmonary embolism (PE) in cancer patients. We evaluated 140 adult patients undergoing major pelvic or abdominal surgery for confirmed malignancies. Baseline and post-operative day 3 TEG parameters (reaction time [R], maximum amplitude [MA], and coagulation index [CI]) and CCA profiles (D-dimer, fibrinogen, and prothrombin time) were tracked. Lower limb duplex ultrasonography screening was performed on post-operative day 7 to detect VTE. Within 14 days post-surgery, VTE was confirmed in 15.0% (21/140) of the patients. In the thrombotic cohort, post-operative day 3 TEG profiles showed hypercoagulability, characterized by a significantly shortened R-time (3.2 ± 0.5 minutes vs. 5.8 ± 1.1 minutes in non-VTE patients, p < 0.001) and an elevated MA value (74.5 ± 4.2 mm vs. 61.2 ± 3.5 mm, p < 0.001). Pre-operative CCA parameters did not show significant predictive differences between groups (p > 0.05). Receiver Operating Characteristic (ROC) analysis showed that a day 3 TEG MA cutoff value > 70 mm predicted VTE development with a sensitivity of 90.5%, a specificity of 84.0%, and an Area Under the Curve (AUC) of 0.91 (95% CI = 0.85–0.96). Viscoelastic testing using TEG provides superior prediction of post-operative thrombotic risks in cancer patients compared to standard assays, serving as a valuable tool to guide extended chemical thromboprophylaxis protocols.

Keywords: Thromboelastography, Surgical Oncology, Venous Thromboembolism, Hypercoagulability, Maximum Amplitude, Thromboprophylaxis

Manuscript Timeline: Received: May 15, 2023; Revised: June 22, 2023; Accepted: July 10, 2023; Published: August 16, 2023.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of Viscoelastic Coagulation Parameters using Thromboelastography to Predict Thrombotic Events in Post-Operative Onconcology Patients. International Journal of Medicine and Medical Sciences, 2023, 13(8): 57–64. DOI: 10.46882/2023/IJMMS/130057

International Journal of Medicine and Medical Sciences | Vol. 13, No. 9, September 2023 | pp. 65–72

DOI: 10.46882/2023/IJMMS/130065

Original Research Article

A Retrospective Assessment of Surgical Site Infection Trends and Microbiological Profiles following Elective Cholecystectomy

Blessing N. Chukwu¹, Patrick E. Lawson², Evelyn M. Kamau¹*

¹Department of Surgery, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria.

²Department of Community Health, College of Health Sciences, Moi University, Eldoret, Kenya.

Abstract:

Keywords: Surgical Site Infection, Cholecystectomy, Laparoscopy, Escherichia coli, Antibiotic Resistance, Perioperative Prophylaxis

Manuscript Timeline: Received: June 11, 2023; Revised: July 20, 2023; Accepted: August 14, 2023; Published: September 15, 2023.

International Journal of Medicine and Medical Sciences | Vol. 13, No. 10, October 2023 | pp. 73–80

DOI: 10.46882/2023/IJMMS/130073

Original Research Article

Evaluation of Spirometric Parameters and Chronic Airway Symptoms among Commercial Flour Mill Workers

Festus M. Tetteh¹, Kingsley C. Amadi², Arthur J. Bond¹*

¹Department of Physiology, School of Biomedical Sciences, University of Ghana, Accra, Ghana.

²Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.

Abstract:

Occupational inhalation of respirable organic flour dust induces chronic airway inflammation, leading to progressive ventilatory changes. This cross-sectional analytical study evaluated the prevalence of respiratory symptoms and alterations in pulmonary function indices among commercial flour mill workers. We matched 150 male flour millers exposed to organic dust for at least 2 years with 150 unexposed healthy male control subjects based on age, height, and body mass index. Respiratory symptom profiles were captured using a standardized questionnaire, and lung parameters were measured via computerized spirometry. Flour millers demonstrated a significantly higher prevalence of chronic productive cough (36.7% vs. 9.3%, p < 0.01), persistent wheezing (22.7% vs. 4.7%, p < 0.01), and exertional dyspnea (28.0% vs. 6.7%, p < 0.01) than the control group. Spirometric evaluation showed significant reductions in Forced Vital Capacity (FVC) (3.28 ± 0.38 L vs. 3.88 ± 0.42 L, p < 0.01) and Forced Expiratory Volume in 1 second (FEV1) (2.38 ± 0.31 L vs. 3.21 ± 0.35 L, p < 0.01) in the exposed group. The FEV1/FVC ratio was also significantly lower in flour millers (72.56 ± 4.8% vs. 82.73 ± 3.4%, p < 0.05), indicating an obstructive pattern of respiratory impairment. Stratified analysis revealed a significant inverse correlation between the duration of occupational exposure and FEV1 reductions (r = -0.55, p < 0.01). Occupational exposure to flour dust significantly impairs lung indices and increases respiratory symptoms. Implementing engineering controls such as local dust extraction systems and requiring personal protective respirators are necessary to protect worker health.

Keywords: Flour Dust, Occupational Exposure, Spirometry, Forced Expiratory Volume, Airway Obstruction, Respiratory Symptoms

Manuscript Timeline: Received: July 14, 2023; Revised: August 22, 2023; Accepted: September 10, 2023; Published: October 13, 2023.

Citation: Tetteh FM, Amadi KC, Bond AJ. Evaluation of Spirometric Parameters and Chronic Airway Symptoms among Commercial Flour Mill Workers. International Journal of Medicine and Medical Sciences, 2023, 13(10): 73–80. DOI: 10.46882/2023/IJMMS/130073

International Journal of Medicine and Medical Sciences | Vol. 13, No. 11, November 2023 | pp. 81–88

DOI: 10.46882/2023/IJMMS/130081

Original Research Article

Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients

Elizabeth A. Cole¹, Moses Z. Tarawallie², Victoria N. Okoye¹*

¹Department of Medical Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.

²Department of Medicine, Connaught Hospital, Freetown, Sierra Leone.

Abstract:

Diabetic foot ulcers (DFUs) are prone to polymicrobial infections, which can lead to osteomyelitis and lower limb amputation if treated with ineffective antibiotics. This prospective cross-sectional study identified the predominant bacterial pathogens and mapped their antimicrobial resistance trends in patients presenting with infected DFUs. Deep tissue biopsies or wound swabs were collected from 140 diabetic patients presenting with Wagner grade 2 to 4 foot ulcers. Bacterial isolation was achieved using standard microbiological criteria, and antimicrobial susceptibility testing was performed using the disk diffusion technique. A total of 185 bacterial isolates were recovered, showing a polymicrobial infection rate of 32.1%. Gram-negative bacilli predominated at 58.4%, with Pseudomonas aeruginosa (24.3%) and Escherichia coli (18.9%) being the most frequent, while Staphylococcus aureus was the most common Gram-positive isolate (35.1%). Antibiogram mapping revealed alarming resistance rates among S. aureus isolates to erythromycin (75.4%) and clindamycin (41.5%), with 38.5% confirmed as Methicillin-Resistant Staphylococcus aureus (MRSA). Gram-negative bacilli showed high resistance to ciprofloxacin (62.8%) and ceftazidime (58.3%), while remaining highly susceptible to amikacin (91.6%) and imipenem (94.4%). Logistic regression showed that a duration of diabetes > 10 years was strongly associated with MRSA infection (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01). Infected DFUs in this region show high rates of multi-drug resistant pathogens. Treatment should be guided by wound culture results rather than empirical protocols to improve healing outcomes and reduce amputation rates.

Keywords: Diabetic Foot Ulcer, Pseudomonas aeruginosa, Staphylococcus aureus, MRSA, Antimicrobial Resistance, Wound Biopsy

Manuscript Timeline: Received: August 18, 2023; Revised: September 25, 2023; Accepted: October 12, 2023; Published: November 15, 2023.

Citation: Cole EA, Tarawallie MZ, Okoye VN. Bacterial Pathogens and Antimicrobial Susceptibility Trends in Wound Infections among Diabetic Foot Ulcer Patients. International Journal of Medicine and Medical Sciences, 2023, 13(11): 81–88. DOI: 10.46882/2023/IJMMS/130081

[Read More]

International Journal of Medicine and Medical Sciences | Vol. 13, No. 7, July 2023 | pp. 49–56

DOI: 10.46882/2023/IJMMS/130049

Original Research Article

A Five-Year Retrospective Trend Assessment of Severe Acute Malnutrition and Clinical Outcomes in a Pediatric Referral Ward

Evelyn N. Kamau¹, Tunde O. Adebayo², Sarah M. Touré¹*

¹Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nairobi, Kenya.

²Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract:

Severe acute malnutrition (SAM) remains a major contributor to under-five child mortality in developing regions, requiring regular audits of clinical care protocols. This retrospective health facility study analyzed five-year trends (2018–2022) and specific predictors of treatment failure among SAM children admitted to a specialized inpatient stabilization center. De-identified medical charts of 650 children aged 6 to 59 months with SAM (defined by weight-for-height Z-score < -3 or presence of nutritional edema) were analyzed. Primary endpoints included cure rate, default rate, and in-hospital mortality rate, assessed according to World Health Organization (WHO) benchmarks. Over the five-year duration, the overall cure rate was 78.5% (510/650), the default rate was 9.2%, and the mortality rate was 12.3% (80/650). The annual trend showed that mortality peaked in 2020 at 15.4% during pandemic service disruptions. The primary direct clinical causes of inpatient death were severe septic shock (38.7%), acute gastroenteritis with severe dehydration (28.3%), and severe bronchopneumonia (18.8%). Cox proportional hazards regression modeling demonstrated that the presence of nutritional edema (kwashiorkor phenotype) (HR = 2.4, 95% CI = 1.3–4.8, p < 0.01), severe hypokalemia < 2.5 mmol/L (HR = 3.1, 95% CI = 1.6–6.2, p < 0.001), and concurrent HIV infection (HR = 2.1, p < 0.05) were independent predictors of inpatient mortality. Inpatient SAM mortality remains above the ideal WHO target (< 10%). Reducing mortality requires earlier detection at the community level, stricter adherence to fluid management guidelines, and aggressive empiric antibiotic treatment for septicemia.

Keywords: Severe Acute Malnutrition, Inpatient Mortality, Kwashiorkor, Sepsis, Dehydration, Pediatric Nutrition

Manuscript Timeline: Received: April 02, 2023; Revised: May 12, 2023; Accepted: June 05, 2023; Published: July 11, 2023.

Citation: Kamau EN, Adebayo TO, Touré SM. A Five-Year Retrospective Trend Assessment of Severe Acute Malnutrition and Clinical Outcomes in a Pediatric Referral Ward. International Journal of Medicine and Medical Sciences, 2023, 13(7): 49–56. DOI: 10.46882/2023/IJMMS/130049

[Read More]

International Journal of Medicine and Medical Sciences | Vol. 13, No. 6, June 2023 | pp. 41–48

DOI: 10.46882/2023/IJMMS/130041

Original Research Article

Efficacy of Low-Dose Oral Progesterone versus Transdermal Estradiol for the Management of Postmenopausal Vasomotor Symptoms

Fatima Z. Bello¹, Kwaku A. Mensah², Grace N. Ojo¹*

¹Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria.

²Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Abstract:

Postmenopausal vasomotor symptoms can significantly reduce quality of life, requiring effective and well-tolerated hormone therapy options. This randomized, open-label, comparative clinical trial evaluated the therapeutic efficacy and safety of low-dose oral micronized progesterone versus transdermal estradiol patches for the management of hot flashes and night sweats in postmenopausal women. A total of 150 symptomatic postmenopausal women were randomly assigned to receive either oral progesterone (100 mg daily, n = 75) or a transdermal estradiol patch (50 μg daily, n = 75) for 12 weeks. The primary outcome was the reduction in the frequency and severity of vasomotor symptoms, assessed using a daily symptom diary and the Hot Flash Daily Score (HFDS). Both treatment modalities led to significant symptom reductions; however, transdermal estradiol achieved a significantly greater reduction in mean weekly hot flash frequency (74.5% decrease from baseline) compared to oral progesterone (58.2% decrease, p < 0.01). Mean HFDS scores also improved more in the estradiol arm (p < 0.05). In contrast, sleep quality scores improved significantly more in the oral progesterone group compared to the transdermal estradiol cohort (p < 0.01), likely due to the sedative properties of progesterone metabolites. Adverse events were mild, with minor breast tenderness more frequent in the estradiol group (14.7%) and mild somnolence more common in the progesterone arm (12.0%). Both therapeutic options are effective, but transdermal estradiol offers superior control of hot flashes, while oral progesterone provides better sleep benefits for symptomatic postmenopausal women.

Keywords: Menopause, Vasomotor Symptoms, Estradiol, Progesterone, Hormone Therapy, Sleep Quality

Manuscript Timeline: Received: March 11, 2023; Revised: April 19, 2023; Accepted: May 15, 2023; Published: June 15, 2023.

Citation: Bello FZ, Mensah KA, Ojo GN. Efficacy of Low-Dose Oral Progesterone versus Transdermal Estradiol for the Management of Postmenopausal Vasomotor Symptoms. International Journal of Medicine and Medical Sciences, 2023, 13(6): 41–48. DOI: 10.46882/2023/IJMMS/130041

[Read More]

International Journal of Medicine and Medical Sciences | Vol. 13, No. 5, May 2023 | pp. 33–40

DOI: 10.46882/2023/IJMMS/130033

Original Research Article

Prevalence of Microvascular Complications and Glycemic Correlates in Middle-Aged Patients with Type 2 Diabetes Mellitus

Chidi O. Okafor¹, Amina J. Hassan², Samuel K. Appiah¹*

¹Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

²Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana.

Abstract:

Chronic hyperglycemia leads to progressive microvascular damage, increasing the risk of blindness, renal failure, and peripheral neuropathy in type 2 diabetes mellitus (T2DM) patients. This cross-sectional analytical study evaluated the prevalence of microvascular complications and their relationship with glycemic parameters in middle-aged diabetic patients. We evaluated 180 T2DM patients aged 40 to 60 years who had been managed for at least three years. Diabetic retinopathy was assessed via dilated fundoscopy, nephropathy via microalbuminuria assays, and neuropathy using the Michigan Neuropathy Screening Instrument (MNSI). Glycemic control was determined using Glycated Hemoglobin (HbA1c), with values ≥ 7.0% defined as poor control. The mean duration of diabetes was 6.8 ± 3.2 years, and the mean HbA1c was 8.1 ± 1.5%. The overall prevalence of at least one microvascular complication was 48.3% (87/180). Peripheral neuropathy was the most common microvascular complication (31.7%), followed by diabetic nephropathy (24.4%) and retinopathy (18.3%). Concurrent presence of all three complications was confirmed in 5.6% of the participants. Logistic regression modeling demonstrated that poor glycemic control (HbA1c ≥ 7.0%) was strongly associated with a higher risk of diabetic nephropathy (OR = 3.4, 95% CI = 1.8–6.5, p < 0.001) and retinopathy (OR = 2.9, p < 0.01). A longer duration of diabetes (> 5 years) also served as an independent predictor of complication risk. Microvascular complications are common among middle-aged diabetic patients and are closely linked to poor glycemic control, highlighting the importance of early intensive metabolic management.

Keywords: Type 2 Diabetes Mellitus, Diabetic Neuropathy, Diabetic Nephropathy, Diabetic Retinopathy, HbA1c, Microvascular Complications

Manuscript Timeline: Received: February 14, 2023; Revised: March 22, 2023; Accepted: April 11, 2023; Published: May 12, 2023.

Citation: Okafor CO, Hassan AJ, Appiah SK. Prevalence of Microvascular Complications and Glycemic Correlates in Middle-Aged Patients with Type 2 Diabetes Mellitus. International Journal of Medicine and Medical Sciences, 2023, 13(5): 33–40. DOI: 10.46882/2023/IJMMS/130033

[Read More]

International Journal of Medicine and Medical Sciences | Vol. 13, No. 4, April 2023 | pp. 25–32

DOI: 10.46882/2023/IJMMS/130025

Original Research Article

Neuroprotective and Antiperoxidative Actions of Centella asiatica Extract against Aluminium Chloride-Induced Neurotoxicity in Wistar Rats

Mustapha T. Gidado¹, Rose C. Obi², Elizabeth W. Wanjiku¹*

¹Department of Pharmacology, Faculty of Pharmaceutical Sciences, University of Maiduguri, Maiduguri, Nigeria.

²Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya.

Abstract:

Chronic aluminum exposure causes progressive neurodegeneration through structural modifications driven by oxidative stress and lipid peroxidation. This experimental animal study examined the neuroprotective and antiperoxidative potential of a methanolic extract of Centella asiatica leaves (MECA) against aluminum chloride (AlCl₃)-induced neurotoxicity in male Wistar rats. Thirty-five adult rats were randomly assigned to 5 equal groups: Normal Control, AlCl₃-alone (100 mg/kg, orally for 28 days), Vitamin E reference control (100 mg/kg), and two treatment groups receiving MECA (200 and 400 mg/kg) orally for 28 consecutive days alongside AlCl₃ administration. Cognitive performance was evaluated using the Morris water maze, while brain tissue analysis quantified lipid peroxidation, acetylcholinesterase (AChE) activity, and antioxidant enzyme concentrations. Exposure to AlCl₃ caused severe cognitive decline, indicated by increased escape latency time, a significant elevation in brain malondialdehyde (MDA) levels, and a substantial increase in AChE activity (p < 0.01). Pre-treatment with MECA (especially at 400 mg/kg) significantly protected against neurotoxicity, lowering mean escape latency, reducing brain MDA concentrations, and decreasing AChE activity (p < 0.01 vs. AlCl₃-alone group). Furthermore, MECA successfully restored brain superoxide dismutase (SOD) and reduced-glutathione (GSH) concentrations. Histopathological evaluation confirmed these findings, showing a preservation of pyramidal cell architecture and a reduction in neuronal vacuolation in the hippocampus. Centella asiatica extract offers significant protection against AlCl₃-induced neurotoxicity by suppressing oxidative stress and preserving cholinergic transmission.

Keywords: Centella asiatica, Aluminum Chloride, Neurotoxicity, Oxidative Stress, Lipid Peroxidation, Cognitive Function

Manuscript Timeline: Received: January 10, 2023; Revised: February 18, 2023; Accepted: March 12, 2023; Published: April 14, 2023.

Citation: Gidado MT, Obi RC, Wanjiku EW. Neuroprotective and Antiperoxidative Actions of Centella asiatica Extract against Aluminium Chloride-Induced Neurotoxicity in Wistar Rats. International Journal of Medicine and Medical Sciences, 2023, 13(4): 25–32. DOI: 10.46882/2023/IJMMS/130025

[Read More]