Journal of Advances in Medicine and Medical Research

Aim: We report an extremely unusual case of thyrotoxicosis presenting as recurrent acute flaccid quadriparesis in a south Indian male. This case is reported to disseminate knowledge about this rare presentation of thyrotoxicosis among medical professionals.

Presentation of Case: This patient presented with sudden onset of symmetrical weakness of both upper and lower limb since early morning with unexplained hypokalemia. He had diffuse toxic goiter with subtle features of hyperthyroidism associated with flaccid quadriparesis. Laboratory investigation revealed marked hypokalemia and hyperthyroidism. He was clinically diagnosed to have hyperthyroidism presenting as thyrotoxic periodic paralysis. He improved with potassium supplementation, beta blocker & anti-thyroid agent.

Discussion: Thyrotoxic periodic paralysis (TPP) may be the initial presentation of thyrotoxicosis in rare occasion. Proximal muscle weakness of lower limb is often the first symptom noted. Hypokalemia noted in TPP is the consequence of a rapid and massive shift of potassium from the extracellular into the intracellular compartment, mainly into the muscles. TPP is distinguished from other forms of periodic paralysis (especially hypokalemic periodic paralysis) with thyroid function tests. Failure to recognize this rare disorder may result in fatal cardiac arrhythmia which is a potential cause of mortality.

Conclusion: Clinicians should be aware of this atypical presentation of thyrotoxicosis as it is lethal if not treated. Young people with unexplained hypokalemic paralysis even without apparent evidence of thyroid dysfunction should be subjected to thyroid function test to identify this rare disorder.

Aims: HIV and AIDS is a major public health challenge and India alone accounts for 2.5 million of the Asian sub continent 2009 estimated 4.89 million people were living with HIV/AIDS. The oral manifestations are often among the first symptoms of HIV/AIDS and thus can be useful in early detection of the disease. Therefore it is professional and ethical responsibility of the dentist to provide treatment to such patients. Therefore, the present study was carried out to assess the knowledge and attitude of dentist and Dental auxiliary staff in a private Dental College.

Study Design: Descriptive cross sectional study.

Methods: A descriptive cross sectional study was carried out for one month among the dentists and dental auxiliary staff. Information, thus obtained from above questionnaire was entered in MS excel spreadsheet and the percentage was calculated.

Results: Fifteen (30%) of the dentists had excellent knowledge regarding modes of transmission of HIV/AIDS while 18 (36%) of nurses had extremely poor knowledge. Thirty (60%) of the dentists had a positive attitude towards HIV/AIDS patients while 25 (50%) of the dental nursing staff and 9 (45%) of the Lab Technicians had negative attitudes towards them.

Recommendation: Regular continuous medical examination of dental health workers is advised for the up gradation of their knowledge and building of strong positive attitudes towards HIV/AID patients.

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) strains possessing virulence genes encoding such toxins as exfoliative toxins (ETs), toxic shock syndrome toxin-1 (TSST-1), is worrying, especially in relation to the increasing frequency of nosocomial infections. The present study aimed to determine the prevalence of genes encoding ETs and TSST-1 in MRSA isolates by polymerase chain reaction (PCR). The results showed that out of 88 investigated MRSA isolates, tst and etb toxin gene were found in 3 (3.4%) and 2 (2.3%) respectively, while none eta toxin genes were detected. It was concluded that the incidence of ET and TSST-1encoding genes among MRSA isolates in Makkah is lower or near to the global prevalence.

Upper gastrointestinal bleeding (UGB) has important morbidity and mortality risk and these risk increases when co-morbidities exist. Nonsteroidal anti-inflammatory drugs use and Helicobacter Pylori infection are risk factors for peptic ulcer bleeding. Peptic ulcer disease is the most common cause of non variceal UGB. However, other rare causes should be responsible for UGB especially in treatment resistant cases.

Background: School children are a high risk population for refractive errors (REs). Uncorrected REs can adversely affect the learning abilities and mental development of school children.

Objectives: This cross sectional study was conducted to observe the proportion of cases diagnosed with REs, to determine factors associated with it, to find out the practices of students in preventing these risk factors and to assess the perception towards visual aids among students with REs in schools of an urban area.

Methods: This study was done in Mangalore city in February 2013. 482 high school children were interviewed using a structured interview schedule. RE was ascertained based on records of previous diagnosis by Ophthalmologist. Data was analyzed by Chi-square test and binary logistic regression analysis.

Results: The prevalence of already diagnosed cases of RE was 94(19.5%). Most of these cases had myopia 92(97.9%). Two cases were of hypermetropia. Mean age of onset of RE was 10.2±2.1 years. Only 19(20.2%) cases were first detected in schools in spite of functioning school health services at all the surveyed schools. RE cases were significantly more in private schools in comparison to government schools (P<0.001). Risk factors significantly associated with RE were history of RE among siblings (P<0.001), inadequate reading distance (P=0.011) and doing homework with inadequate illumination (P=0.021). One third of students with RE were irregular in eye examinations.

Conclusion: Proportion of REs was high among school students. Education of students on healthy postural habits and good illumination while studying at home is essential to prevent REs in this population.

Background: Influenza is an acute respiratory disease that has caused pandemic in birds and humans. Therefore, this study was designed to isolate and identify influenza A virus strains from live bird handlers in life bird markets (LBM) and poultry farms in Ibadan metropolis.

Methods: A total of 43 oropharyneal swabs were collected over a period of four months and tested for influenza A virus. Isolation was done by virus culture in MDCK cells and ten to twelve day old embryonated chicken eggs. Detection of RNA of the virus was carried out using real time PCR. Statistical tools employed were percentages (Multiple Bar Chart) chi square (P=.05 and 1 degree of freedom).

Results: Out of 43 samples collected and tested, 5 (11.6%) were positive for influenza virus in MDCK, 2 (4.7%) in embryonated egg while 16 (37.2%) were positive for influenza A virus by real time PCR. Only 1 (2.3%) was confirmed by the three methods used for detection of influenza A virus in this study.

Conclusion: The occurrence of influenza A virus particles in the samples obtained from live bird handlers confirmed by the methods employed in this study revealed the possibility of cross infection by the virus.

Background: Evolution of Alzheimer’s disease from the onset of dementia to death is estimated by different authors as lasting between a few months and 21 years.

Objective: To verify whether there is an explanation for this dispersion of evolution of cases, starting only from clinical information.

Methods: A number of 75 cases of patients dead between 01. Jan. 2011 and 31. Dec. 2012 were analyzed. Data on deaths was collected from the County’s Statistics Institute; other information was collected from patient charts.

Results: Gender, onset age, co-morbidities and treatment do not influence the dispersion of cases. Dispersion started at less than one month from diagnosis and ended 11.42 years after diagnosis. At the age of 65, a boom in incidence of dementia symptoms as a stage of the disease was recorded. Dispersion of cases was divided into 3 evolution groups: the majority between 0-3 years, followed by 3-6 years and 6-11.42 years, as a Gaussian curve.

Conclusions:

  1. The age of 64-65 may be considered a high risk age and it should be monitored accordingly.
  2. The question of how just was Kraepelin’s disjunction into pre-senile and senile dementias arises.

In terms of evolution, according to dispersion, there are versions of the same disease or different diseases in pathogenesis depth, but similar in symptomatology.

Introduction: The prevalence of disabling hearing loss for adults and children is greatest in South Asia followed by Asia Pacific and Sub-Saharan Africa. Nepal is one of the least developed nation where hearing loss and ear diseases is very common.

Objective: To find out the pattern of ear diseases in the patients attending Ear outpatient department (OPD) of Biratnagar Eye Hospital.

Materials and Methods: A retrospective, descriptive review of data retrieved from the medical record section of the Hospital between January 1, 2014 to December 31, 2014 was done. The data were tabulated and analysed. The results are expressed in number and percentage.

Results: Chronic suppurative otitis media, mucosal (42.64%) and ear wax/otomycosis (24.39%) were the commonest ear diseases found. Eustachian tube dysfunction (12.89%), acute otitis  media (0.74%), acute suppurative otitis media (2.9%), otitis media with effusion (0.54%) were other common diseases. Presbyacusis (10.09%) was found to be a common problem in adults. Various other external auditory canal problems and those of inner ear were also detected.

Conclusions: Ear diseases are one of the major health problems in Nepal. This study has found chronic otitis media and ear wax/otomycosis to be commonest problems in children and adults attending the Ear OPD of Biratnagar eye hospital.

This reserach study investigated how satisfied medical workers comprising of doctors, nurses and hospital administrators were with their jobs and roles in the hospital setting. The research specifically sort to unveil whether doctors were more satisfied than nurses and or administrators or vice versa. The sample used for the study were 120 medical workers drawn from a University Teaching Hospital in Nigeria. The breakdown of the subject were as follows: Medical doctors – 40, nurses – 40 and administrators 40. The instrument used in the study to measure job satisfaction was [1] Job descriptive index; r = .83 [1] and .93 [2]. The design adopted for the study was a T x S ANOVA Design and One – Way ANOVA for equal sample sizes was used for data analysis. The result revealed that there was a statistically significant difference in the satisfaction levels of medical workers [F(2,117) = 13.9 p<.05]. Nurses were more satisfied than doctors while the administrators were the least satisfied. The implication is that when medical workers are not satisfied with their jobs, it translates into reduced level of health care and attention given to the patients.

It is proven that breast conservative surgery plus radiotherapy is safe and has equivalent results when compared to mastectomy. It is known that positive surgical margins increase the risk of local recurrence. The effect of increasing negative margin width after breast-conserving therapy on local recurrence is controversial. There is no consensus on what constitutes adequate negative margins in breast conservative surgery. There is also an evident association between widely negative margins and excessive breast tissue ressection, with poor cosmetic outcomes. Besides, reexcisions represent elevated costs and psychological trauma to the patients. Definition of what constitutes an adequate margin for both invasive and noninvasive breast cancer is clearly needed. We review here the evolution of surgical margins concepts in breast cancer and try to establish the ideal and current surgical approach for each patient.