Open Access Case Study

Primary Intracerebral Haematoma Evacuation: A Case Report

Tomaz Velnar, Gorazd Bunc

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/23237

Spontaneous intracerebral hemorrhage is one of the most devastating types of stroke, leading to disability and high mortality rate. Besides blood pressure reduction and intensive medical and surgical treatment, immediate coagulopathy reversal is vital. On the other hand, the haemostatic disturbances may contribute to improve the recovery. We describe the evacuation of intracerebral hemorrhage with the insertion of external ventricular drainage in a patient suffering from deep hypertensive intracerebral haemorrhage and haematocephalus.

Open Access Minireview Article

Office-Based Olfaction Assessment

Erdem Atalay Çetinkaya, Nuray Bayar Muluk, Cemal Cingi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25060

A simple assessment of olfactory acuity is essential and can play a vital role in patient care and quality-of-life parameters. Any process that interferes with the physiologic environment of the nasal mucosa can be associated with restricted olfaction. Studies have examined how the human sense of smell likely integrates information from complex arrays of odorant chemicals that, individually, would seem to produce conflicting odorous sensations. “Scratch and sniff” format screening tests are readily available and have been standardized for age, gender, and ethnicity. It is important to identify a scent that can be used as in an initial olfactory test If a patient cannot identify this scent, they should  take further diagnostic testing.

In this review, we give some essential information on office-based olfaction assessment and attempt to cover important aspects of the evaluation, especially from a clinical perspective.

Open Access Original Research Article

Perception of Educators about Quality of Diabetes Education Services at Primary Health Care Level in Khartoum State, Sudan

Siham Ahmed Balla, Kamil Mirghani Ali Shaaban, Haiedr Abu Ahmed Mohamed, Mohamed Ali Awadelkareem, Asia Abdullah Belal

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24943

Introduction: Promoting positive life style is a strategy for delaying and reducing the incidence of diabetes complications.

Objective: To determine the perception of educators about the quality of education services provided to diabetic patients at the health centers in Khartoum State.

Methods: A qualitative descriptive study carried out among 22 educators working at governmental and non-governmental health centers. Mini focus groups of discussion were moderated by a qualified social researcher and a trained note taker. The guiding questions included general information and several questions about education services for diabetic patients. Ethical clearance was obtained from relevant ethical committees. Informed consent was obtained from educators. Content analysis of data was carried and organized in to themes. The themes were organized according to the dimensions of quality of care, structure, process and outcome.

Results: All educators were females.  Their ages were between 25-55 years. The majority were holders of a university degree with different basic disciplines. The working duration ranged between 3 to 25 years. Ten of them were working in governmental health centers and 12 in non-governmental ones. Few educators were trained on diabetes education (structural quality care). Most of them agreed on the lack of diabetes education materials and specific education program (structural quality care). The majority agreed on the absence of team work and their role is to weight the patients. Most of educators educate individuals rather than groups (process quality care). The majority was not satisfied with education services at the health centers and most of educators reflected the poor knowledge and negative behaviour of the diabetic patients (outcome quality care).

Conclusions: Diabetes education services at primary health care are insufficient. Most of educators were not certified educators. Education services lack team work and strategic plans. Diabetic patients have poor knowledge and behaviour regarding diabetes management.

Open Access Original Research Article

Renal Function Assessment of Workers Occupationally Exposed to Hair and Nail Care Products in Benin City, Edo State

H. B. Osadolor, O. G. Igharo, A. F. Onyeogalu

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/24619

Cosmetology is a profession with a population of mostly women, who are exposed to a myriad of chemicals of concern every day in their workplaces. Research shows that salon workers are at greater risk for certain health problems compared to other occupations. This study aims at evaluating the renal function of nails and hair care workers in Benin City who are exposed to cosmetic borne toxicants. Blood samples were collected from hair and nail care workers resident in Benin City, Edo state, Nigeria for urea creatinine and electrolyte evaluation. Urea was analyzed by the urease-betherlot process, creatinine was analyzed using modified jaffe-slot technique, sodium and potassium ions were analyzed by flame emission spectrophotometry while chloride and bicarbonate ions were analyzed using Schales and Schales method and acid-base back titration respectively. Plasma levels of urea and creatinine was significantly higher in cosmetologist than heavy cosmetics users and cosmetic nave participants (p<0.000). Sodium and Chloride were also found to be reduced in cosmetologists than heavy cosmetics users and cosmetic naive participants (p<0.000). The results obtained from this study may be suggestive of renal damage. However, it is recommended that salon workers and salon owners should be enlightened so as to improve their awareness of the risks associated with the exposure toxic chemicals in hair and nail care products. And also further studies be carried out on a larger scale in order to further assert these claims.

Open Access Original Research Article

Patient Dose Assessment for Common Digital Diagnostic Radiology Examination in Hamad Medical Corporation Hospitals in the State of Qatar

Huda M. Al-Naemi, Ibrahim I. Abdallah, Osman B. Taha, Mahmoud A. Tarabieh, Nabil A. Iqeilan, Samya M. Al-Manea, Abeer O. Al-Attar, Mohamad H. Kharita, Antar E. Aly

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/23975

The aim of this study was to estimate radiation doses to patients undergoing standard radiographic examinations using Computed Radiography (CR) and Direct Digital Radiography (DDR) in two hospitals within Hamad Medical Corporation (HMC) in Qatar, and compare the results with regional and international Diagnostic Reference Levels (DRLs). Data on 3391 patients were recorded from different X-ray rooms in HMC hospitals. Entrance Skin Dose (ESD) was measured for 1046 patients for the most five common X-ray examinations (a total of 7 projections) namely: Skull, Chest, Abdomen, Lumbar Spine and Pelvis. Exposure factors such as kV, mAs and Focal to Skin Distance (FSD) were recorded for each patient. Tube Output was measured for a range of selected kV values. ESD for each individual patient was calculated using the tube output and the technical exposure factors for each examination. The ESD values were compared with some international DRLs for all types of examinations. HMC patient demographic data evaluated from this study were: average age of 39 years, average weight of 60-80 kg and mean height of 165 cm. The most procedure performed during the time of this study was chest PA (52%), and the least procedure performed was skull AP/LAT (1%) examination. The mean ESD values found to be generally lower than the published values. With exception of abdomen examinations at Hamad General Hospital (HGH), mean ESD values were found to be within the established IAEA (DRL). The mean ESD values at HGH were found to be much higher than that at Al Khor Hospital (AKH) for abdomen, Lumbar spine AP, Lumbar Spine LAT and pelvis, but generally lower than the published values.

Open Access Original Research Article

Appropriateness of Indication and Diagnostic Yield of Colonoscopy in a Southern Nigerian Tertiary Hospital

R. A. Ugiagbe, C. E. Omuemu, F. A. Imarhiagbe

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24675

Background and Objectives: For optimum use of resources in an open access system, official guidelines for the appropriate use of colonoscopy have been proposed by the American Society for Gastrointestinal Endoscopy (ASGE). The objectives of this study were to determine the appropriateness of referrals and to assess the diagnostic yield of colonoscopy based on the 2000 ASGE guidelines.

Methods: This was a retrospective study of patients that had colonoscopy in the University of Benin Teaching Hospital from January 2010 to December 2014. The biodata, indications for the procedure, and findings at colonoscopy were retrieved from the colonoscopy register of the endoscopy unit. The year 2000 ASGE guidelines were used to determine the appropriateness of indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for the indication.

Results: Of the 283 patients (158 males; 125 females; mean age 55.2±15.0 years) studied, 66% had colonoscopy for an indication that was considered ‘generally indicated’. It was ‘generally not indicated’ for 2.5%, while 31.4% underwent colonoscopy for reasons ‘not listed’ in the guidelines. The diagnostic yield of the procedure was significantly higher in the ‘generally indicated’ group (41.7%) than in the ‘not listed’ (29.2%) and the generally not indicated (0%) groups. In the multivariate analysis, diagnostic yield was associated with appropriateness of indications that was’ generally indicated’ (odds ratio=1.263, confidence interval=1.072-1.488).

Conclusion: About one third of patients had colonoscopy performed for reasons considered inappropriate by the ASGE 2000 guidelines. The diagnostic yield of colonoscopy is predicted by the appropriateness of the indication. Positive diagnostic yield also occurs in the unlisted category. Further studies are required to evaluate the indications for colonoscopy and the possibility of adding some of the unlisted indications to the ASGE guidelines in future revisions. There is need to develop a local guideline well adapted to our environment.

Open Access Original Research Article

Errors in Clinical Biochemistry Laboratory

Usha Adiga, A. Preethika

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/25012

Introduction: Clinical laboratories have focused their attention on quality control methods and quality assessment programs dealing with analytical aspects of testing. But studies in recent years demonstrates that quality in clinical laboratories cannot be assured by merely focusing on analytical aspects. But mistakes occur more frequently before (pre-analytical) and after (post-analytical) the test has been performed. Objective of our study is to analyze the causes of errors occurring in our Clinical Biochemistry Laboratory and categorize them, find the frequency and percentage of errors.

Methodology: This study was carried out in a newly established Clinical biochemistry laboratory.  Causes of errors were noted down and were categorized in to pre analytical, analytical and post analytical errors. Data has been noted down from April 2015 to December 2015.

Results: Pre analytical errors were contributing significantly to laboratory errors (59.8%) as compared to analytical (30.84%) and post-analytical errors (9.35%). Hemolyzed and clotted samples were the main causes of pre analytical errors (37.5% and 21.87% respectively). Calibration drifts were contributing mainly to analytical errors (39.39%).Transcription error (60%) was the main contributor to the post analytical error.

Conclusion: Errors can be minimized by training the laboratory personnel regarding phlebotomy techniques, storage, transport of specimen, instrument handling .Computerization of entire process will help to minimize the errors. The success of any efforts to reduce errors must be monitored in order to assess the efficacy of the measures taken. In the testing process areas involving non-laboratory personnel, interdepartmental communication and cooperation are crucial to avoid errors.

Open Access Original Research Article

Neuropathic Pain in Patients with Sciatica: Prevalence and Related Factors

Ben Tekaya Aicha, Tekaya Rawdha, Mahmoud Ines, Sahli Hana, Saidane Olfa, Zaghdani Imen, Abdelmoula Leila

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/24688

Aim: To assess the prevalence of neuropathic pain (NP) in patients with sciatica and to determine the associated factors with increased incidence of neuropathic component in sciatica.

Methods: A cross-sectional study enrolled 80 patients with sciatica from a rheumatology outpatient Hospital. Pain severity was measured us­ing the Visual Analogue Scale (VAS). The prevalence of NP was assessed according to the Douleur Neuropathique 4 (DN4). Statistical analysis was performed to find the factors closely related with NP.

Results: A total of 70% of the participants were classified as having NP. The DN4 score≥4 was not significantly cor­related with VAS, but was significantly associated with gender (sex ratio=0.9; p=0,013), low educational level (p=0,008), illiteracy (p=0,012), chronic disease (p=0,019) and facet joint osteoarthritis (p=0,06). In multivariate logistic regression analysis, only chronicity of the disease remained an independent factor associated with NP in sciatica (OR=5,8).

Conclusion: In the present study, NP was a major contributor to sciatica and the DN4 scale was a practical and rapidly administered screening tool for distinguishing the relative contributions of neuropathic component. The knowledge of the associated factors with NP in sciatica may improve the management of NP when these factors can be modified and targeted for treatment.

Open Access Original Research Article

Effects of Tramadol on Fertility Hormones (Follicle Stimulating Hormone, Leutinizing Hormone, Prolactin, Testosterone, Estrogen and β-HCG) in Laboratory Rabbits

H. B. Osadolor, J. A. Omo-Erhabor

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/24620

Drug abuse in Nigeria has been indicated to be on the rise in recent years. The use of hard drugs and misuse of prescription drugs for nonmedical purposes cuts across all strata, especially the youths. Tramadol (2[(Dimethylamin) methyl]-1-(3-methoxyphenyl)cyclohexanol) is known for its analgesic potentials. This potent opioid pain killer is misused by Nigerian youths, owing to its suspicion as sexual performance drug. This study therefore is aimed at determining the effect of tramadol on hormone levels its improved libido properties and possibly fertility. Twenty seven (27) European rabbits weighing 1.0 to 2.0 kg were used. Animals were divided into four major groups consisting of male and female control, and male and female tramadol treated groups. Treated groups were further divided into oral and intramuscular (IM) administered groups. Oral groups were administered 25 mg/kg b.w. of tramadol per day while the IM groups received 15 mg/kg b.w. per day over a period of thirty days. Blood samples were collected at the end of the experiment for progesterone, testosterone, estrogen (E2), luteinizing hormone, follicle stimulating hormone (FSH), β-human chorionic gonadotropin and prolactin estimation. Tramadol treated groups were compared with control groups at the end of the study, as well as within group comparison was done. From the results, FSH was found to be significantly reduced (p<0.05) while LH increased significantly (p<0.05).  A decrease was observed for testosterone (p<0.001), and estrogen, FSH, progesterone also decreased (p<0.05). Significant changes weren’t observed when IM groups were compared with oral groups. This study does not support an improvement of libido by tramadol, though its possible usefulness in the treatment of premature ejaculation may have been established, but its capabilities to induce male and female infertility is still in doubt.

Open Access Original Research Article

Association between Family Developmental Stages and Clinical Manifestations of Patients with Psychosomatic Morbidity Presenting at a Primary Care Clinic in South-West Nigeria

O. A. Ajetunmobi, A. A. Adetunji, M. M. A. Ladipo, O. M. Shabi, O. E. Gabriel

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/24511

Aim: This study aimed to find out the relationship between the clinical manifestations of patients with psychosomatic morbidity (PSM) and their family developmental stages.

Study Design: A cross sectional study.

Place and Duration of Study: The study period span between February 1st and April 30th 2013, during which patients who presented at the General Outpatient (GOP) clinic of the University College Hospital, Ibadan for various complaints were encountered.

Methods: A sample of 360 patients with varying forms of PSM identified by five or more from the symptoms in the primary evaluation of mental disorder- patient health questionnaire somatoform, anxiety and depression modules (PRIME-MD PHQ SADs) was recruited consecutively. The international classification for primary care second electronic version (ICPC-2E) was used to categorize the clinical manifestations of respondents while Stevenson’s family developmental model classified the family developmental stages into emerging, crystallizing, interacting and actualizing family. Data were analyzed using statistical package for social sciences soft ware version 17. Statistical significance level was set at p ≤ 0.05.

Results: Among the 360 respondents studied, 275 were married with age range between 19 and 80 years, 62.5% lived with their spouses, 3.1% divorced∕ separated and 10.8% were widowed. Majority was females (74.9%) and the predominant family developmental stage was the crystallizing family (30.2%). General and unspecified physical (GUP) complaints were the commonest clinical manifestation seen in all the stages except the emerging family which has gynaecological complaints. Comparing the mean scores of married respondents with moderate-severe PSM and family stages  shows that being married and living with spouses may be protective against severe forms of PSM (P = .04). On the other hand, comparing the mean scores of single and married respondents with moderate-severe PSM shows that respondents who are single may come with severe forms of somatoform disorder when compared with other single respondents with anxiety or depressive disorder (P < .05). There is however no relationship between the family developmental stage and severity of PSM.

Conclusion: There was interplay between medically unexplained physical complaints and patient’s family characteristics. Being married and living with spouses may be protective against severe forms of PSM.