Open Access Case Study

Anaesthetic Management during Transposition of Great Arteries (TGA) Correction: Points to be Focussed

Swati Gupta, Anjum Saiyed, Reema Meena, Neelam Dogra

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/30290

Transposition of great arteries (TGA) is combination of concordant atrioventricular and discordant ventriculo-arterial connections and is divided into dextro-looped (d-TGA) and levo-looped (l-TGA) based on whether the atria and ventricles are concordant or discordant, respectively. Arterial switch operation is the procedure of choice but other surgical surgical options exists. In our case, a 4 month old boy presented with cyanosis, delayed milestone, diagnosed d-TGA with ASD came for surgical repair. Arterial switch repair was planned but due to decreased right ventricular pressure and raised pulmonary arterial pressure, mustard-senning procedure was performed. Hypoxia, systemic hypoxemia, metabolic acidosis, hypercarbia, sympathetic nervous stimulation due to light plane of anaesthesia can trigger a rapid rise in PVR, and even a pulmonary hypertensive crisis. Our aim was to prevent alteration in SVR and PVR in order to prevent desaturation especially at time of induction and off CPB bypass.

Open Access Case Study

An Uncommon Clinical Presentation of a Calcifying Epithelial Odontogenic Tumor (Pindborg Tumor): Case Report and Review

Parul Tandon, Harish Saluja, Wamiq Musheer Fareed, Tazeen Fatima, Shivani Sachdeva, Hathan Fahad Al-Ghabban, Ibrahim Saleh F. Alraddadi

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/29406

The calcifying epithelial odontogenic tumor (CEOT) is a benign tumor, accounting for 0.4-3% of all odontogenic tumors. It mostly occurs in the 4th to 6th decades of life with equal propensity for both the genders. In about 52% of cases, the tumor is found in association with an unerupted tooth, with lower jaw being more commonly involved. It is usually asymptomatic and often causes bone expansion similar to other odontogenic tumors; therefore, diagnosis depends upon the lesion’s histologic features. We report a clinical presentation of CEOT not associated with unerupted teeth and occurring in the anterior mandible of a 16 years old male. The tumor was treated by surgical removal with no sign of recurrence after a period of 6 months. The surgery required complete removal including adequate margins of normal tissue in order to ensure complete removal.

Open Access Original Research Article

Acquisition of Competence in Clinical Practical Procedures: A Model of the University of Zambia Medical School

Katowa-Mukwato Patricia, Banda S. Sekelani

Journal of Advances in Medicine and Medical Research, Page 1-14
DOI: 10.9734/BJMMR/2017/31279

Aims: To explore how medical students acquired and developed competence in selected clinical practical procedures.

Study Design: Cross sectional qualitative study.

Methodology: Seventeen (17) students from a class of 60 final year University of Zambia Medical students of the 2012/2013 academic year participated in the in-depth interviews. The in-depth interviews were conducted using Grounded Theory approach.

Results: Twelve themes emerge on how medical students of the University of Zambia, learn and develop competency in clinical practical procedures. Eight of the themes describing the process of learning, while the other four describes the process of competency development. The eight themes on learning are: learning through formal teaching, informal teaching, observing/watching, demonstration, apprenticing, and being “put on the spot”. Other were learning passively and learning from reading medical literature. Themes for describing the process of competency development included; personal interest, more practice, reading literature and teaching others. From the twelve themes, a new model has been advanced called “Passive Observation to Peer Teaching Model” of clinical procedural skills acquisition and competency development which describes how Medical students of the University of Zambia-acquired and developed competence in clinical practical procedures.

Conclusion: The model generated from our study can be seen as an expanded version of the “see one, do one and teach one approach” with an expansion of the “doing one” which in our model is first guided then unguided. One notable difference between existing models and that from our study is, while existing models focus on actual manipulations to perform a psychomotor skill, our model focuses on the process of acquiring and developing competency.

Open Access Original Research Article

Factors Affecting Female Patient Satisfaction with Their Dental Aesthetics and Their Treatment Choice to Achieve the Most Desired Dental Appearance

Wadiaah Almadani, Samah Saker

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/30455

Aim: Since aesthetics has become an important issue in dental treatment, it seems important to have a good communication between a patient and the dentist to understand the patient's concept regarding the dental aesthetics and to achieve the most desired dental treatment.

So, the aim of this study to investigate the significant predictors influencing a patient's decision to choose prosthetic, orthodontic, restorative or bleaching type of therapy.

Methods: A total of 165 female patients who attended dental clinics at Taibah University (2015-2016) participated in this cross sectional study (aged 18 years old and over). The study included a pre-structured questionnaire based on the degree of satisfaction with general dental appearance (yes or no questions) and type of treatment they desire to undergo. Collected data were analyzed using chi square test at a 95% level of significance.

Results: This study recruited 165 female of whom 165 (100%) responded. 42.4% were not satisfied with dental appearance while 55.8% were not satisfied with tooth color. Percentage of people who prefer seeking orthodontic treatment was 22% and for dental bleaching was 41%. People who prefer undergoing prosthodontic treatment represents 19% of the sample and 18% for people who prefer tooth color fillings.

Conclusion: Dental female patients complained from their teeth color and believe that tooth whitening is the main concern for improvement of their aesthetic. Understanding patients' opinions in choosing type of dental treatment will help the dentists in treatment planning.

Open Access Original Research Article

Performance of First Response® and CareStart™ Malaria Rapid Diagnostic Tests for the Detection of Plasmodium falciparum in a Tertiary Hospital in Ghana

Bernice Ameyaw, Mohamed Mutocheluh, Michael Owusu, Alhassan Abiba Khalifah, Richard Vikpebah Duneeh, Patrick Williams Narkwa

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/30892

Background: Malaria poses a major public health problem in sub-Saharan Africa. In Ghana, millions of people are potentially at risk of Plasmodium falciparum infections annually. The current study evaluated the performance of two Histidine rich protein 2 (HRP-2) rapid diagnostic tests (First Response® and CareStart™) using giemsa stained microscopy (microscopy) as the gold standard. This cross-sectional study which took place at the Komfo Anokye Teaching Hospital (KATH) in Kumasi from October 2014 to March, 2015 was done to monitor the performance of RDTs that are used regularly in Ghana.

Methodology: A total of 400 children (239 males, 161 females; age range 1-17 years) with fever or history suggestive of malaria were included in the study. First Response® and CareStart™ diagnostic accuracy results were compared with that of microscopy. The strength of agreements (kappa) between the microscopy and the two RDTs were also calculated.

Results: Of the 400 blood films that were examined using microscopy, Plasmodium parasites were detected in 33 (8.3%) of them. First Response® showed positive results in 65 (16.3%) and CareStart™ showed positive results in 68 (17.0%). The sensitivities of both First Response® and CareStart™ when compared with microscopy were 97.0% (95% CI: 84.2-99.9) and 97.0% (95% CI: 84.2-99.9) respectively. The specificities were First Response® 91.0% (95% CI: 87.6-93.7) and CareStart™ 90.2% (95% CI: 86.7-93.0). The strength of agreement (kappa) between microscopy and First Response® and CareStart™ with 95% confidence interval was good for the First Response® (giemsa stain microscopy vs First Response®: 0.61) and  moderate for CareStart™ (giemsa stain microscopy vs CareStart™: 0.59).

Conclusion: The diagnostic accuracy of the First Response® and CareStart™ RDTs to detect malaria was good with no significant differences between the two rapid test kits when compared with microscopy. The RDTs are a suitable alternative to microscopy to test for malaria in rural areas.

Open Access Original Research Article

Comparative Analysis of the Effect between FES, RUSSA and AUSSIE Therapeutic Currents in Individuals with Hypertonia Spastic Post Stroke Case Study

Gerson Bruno Baptista, Juliana Cardoso, Bruno Ferreira

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/30644

The effectiveness of treatment by means of electro-stimulation in patients with an increase of spasticity in the affected hemibody after a stroke has been presented in several studies, bringing about the need for conducting researches that seek the most effective electro-therapeutic treatment among those currently existing. This study aims to evaluate the spasticity, equilibrium, muscle activation, muscle efficiency and median frequency after immediate application of the RUSSA, FES and AUSSIE therapeutic method currently, reported being the most effective. Six individuals of the male sex between 40 years of age and older, were selected and divided into the following groups:  group treated with RG – RUSSA ("n = 2”), group treated with FG - FES ("n = 2”) and group treated with AG - AUSSIE ("n = 2”). Before and after electro-stimulation in order to assess the spasticity the Ashworth's Modified Scale was applied, for the evaluation of the equilibrium the Berg’s Balance Scale was utilised and to determine muscular activation, muscular efficiency and the median frequency, surface electromyography was applied. In this case, study considering we hold a small sample we utilised a comparison of the real values for each test, not conducting statistic tests. After a re-evaluation of the Ashworth's Modified scale no differences were found between the initial and final scores, In the Berg’s Balance Scale within both groups there was an improvement in equilibrium and after the application of the surface electromyography there was a lower muscular activity in the AG - AUSSIE group, better muscular efficiency in the AG – AUSSIE group and a decrease in median frequency in the FG - FES group. Up until the present moment, it may be noted that the current methods are effective, especially AUSSIE.

Open Access Original Research Article

Ultrastructure of Teleost Retina II: Interstitial Amacrines, Dislocated Amacrines, Ganglion Cells, Müller Fiber, Oligodendroglia, Adrenergic Terminals, Inner Plexiform Layer, Glycogen Cytochemistry

Jose Antonio O'Daly

Journal of Advances in Medicine and Medical Research, Page 1-25
DOI: 10.9734/BJMMR/2017/31018

Aims: To analyze the ultrastructure of internal interstitial amacrine cell, dislocated amacrine cell, ganglion cells, oligodendroglia, Müller cells, inner plexiform layer, adrenergic terminals, as well as the connections found between the cells and the cytochemistry of glycogen distribution from Mugil brasiliensis teleost retina.

Methodology: The retina was fixed with glutaraldehyde and osmium tetroxide and radial and tangential sections stained with lead citrate and uranyl acetate to be observed in a Hitachi 11B electron microscope at 75Kv. To demonstrate glycogen fragments glutaraldehyde fixed osmium post-fixed were, sectioned in the MT2 ultramicrotome and processed with periodic acid thiosemicarbizide for oxidized molecules.

Results: Retinal morphology revealed external interstitial amacrine cells as the most voluminous cell above inner plexiform layer. Dislocated amacrine cells described by the first time, localized at the inner plexiform layer, had clear cytoplasm, few ribosomes, few vesicles of rough endoplasmic reticulum and elongated mitochondria with clear matrix. Dark and clear amacrine piriform cells were characterized by glycogen density, and their functional contacts described. External horizontal cells, dark piriform amacrines, stellate amacrines and Müller cells exhibited the highest glycogen concentration in teleost fish retina.

Conclusion: This paper is a comprehensive analysis of ultrastructure of five retinal cells, adrenergic terminals inner plexiform layer and glycogen distribution in the retina, finding one new cell, the dislocated amacrine cell and also describing the amacrine interstitial external cell the most voluminous cell in teleost retina.

Open Access Original Research Article

Functional Recovery and Its Predictors after Sub-acute Stroke Rehabilitation in a Nigerian Tertiary Health Facility: A Preliminary Finding

Olufemi O. Oyewole, Kolawole S. Oritogun, Caleb A. O. Gbiri

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/31224

Background: Neurorehabilitation remains one of the main methods of treatment in the management of stroke survivors and its early commencement reduces morbidity and improves function. This study assessed motor function recovery after sub-acute stroke rehabilitation and determines factors that predict the recovery.

Methods: The cohort prospective study includes 30 consecutive in-patients of a tertiary health facility in Nigeria with primary diagnosis of stroke. Their motor function was assessed at admission and discharge using Functional Independence Measure (FIM) and Modified Motor Assessment Scale (MMAS). Descriptive and inferential statistics were used to analyse the data.

Results: Length of rehabilitation/hospital stay ranges between 3 and 60 days (median=16.5 days) and stroke onset interval before admission/rehabilitation ranges between 2 and 28 days (median=8 days). There were significant differences between admission and discharge FIM and MMAS (p=0.001). Only 53.3% achieved Minimal Clinically Important Difference (MCID) in functional recovery as measured by FIM at discharge. Type of stroke (haemorrhagic), motor impairment body side (right) and admission FIM (68.5±30.4) were the predictors of achieving MCID after stroke. Right body side motor impairment are 8 times (OR=7.72; CI=1.08 – 54.97; p<0.05) more likely to achieve MCID in functional recovery compared with left side. The multiple regressions also revealed that stroke type (haemorrhagic) and motor impairment body side were the only significant factors in predicting improved functional recovery after stroke measured by FIM.

Conclusion: More than half of stroke survivors achieved MCID in motor function recovery after sub-acute stroke rehabilitation and side of impairment is the major predictor.

Open Access Original Research Article

Subtotal Thyroidectomy for Giant Goiters under Local Anesthesia: Experience with 15 Nigerians

B. A. Eke, B. A. Ojo, W. T. Yongu, C. Ahachi, P. Denen-Akaa, V. I. Ugwu, P. Abayol, E. O. Umobong

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/25568

Thyroid surgery is performed by majority of surgeons using general anaesthesia with endotracheal intubation. In resource poor countries, the paucity of equipment and Anaesthetists limits such procedure needing endotracheal intubation. We describe our experiences with 15 Nigerians who presented with giant goitres and were operated using local anaesthesia. We concluded that subtotal thyroidectomy under local anaesthesia is safe and cost effective. It should be encouraged in resource poor countries and save the patients from living with the stigmata of goitres when they were not able to pay their ways to centres that use general anaesthesia with endotracheal intubation for such procedure.

Open Access Review Article

A Person-centred View of the Aim, Goals and Tasks in Clinical Supervision: Proposals on Topics for Experiential Learning

Michael D. Callifronas, Susan Brock

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2017/29507

im: This paper intends to highlight and review the traits of the person-centred clinical supervision model. This model is different to ‘mentoring’ supervision models. Specifically, the person-centred model has a minimal degree of directivity when compared to educative, teaching and judgemental supervision models, as the supervisor is not a ‘wise’ expert. S(he) works with trust, empathy, warmth, safety and genuineness within the supervisee’s frame of reference, thus facilitating the supervisee’s experiential learning and development.

Discussion: Details of the aim, goals and tasks of person-centred supervision are explored, and the essential differences from other supervision models are discussed. Areas of ethical concern receive particular exploration. This paper proposes areas of experiential learning that would be helpful if elaborated within the supervisory context.

Conclusion: The person-centred supervision model is focused on the supervisee’s personal and professional development. It necessitates a collaborative perspective to facilitate reflection and conceptualisation, trusting the supervisee’s internal power and resources.