Open Access Case Report

The Usefulness of Rocuronium and Sugammadex in the Anesthetic and Surgical Management of an Infant with Large Mediastinal Mass: A Case Report

Gwi Eun Yeo, Byung Gun Lim, Mido Lee

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/37545

Pediatric patients with large mediastinal mass are in danger of having critical respiratory and hemodynamic problems during anesthetic and surgical process. Traditionally, the key to the success of anesthetic management in pediatric patients with mediastinal mass is to keep spontaneous respiration without administration of muscle relaxants during the whole anesthetic period. Nevertheless, spontaneous respiration may interfere with fine important surgical procedures compared to mechanical ventilation. We hypothesized that a new anesthetic strategy using rocuronium and sugammadex might facilitate mechanical ventilation and surgical procedures, and provide complete and fast recovery of neuromuscular and respiratory function without respiratory complication. Here, we present an infant with severely compressed airway due to large mediastinal mass successfully managed with a special anesthetic strategy including use of rocuronium and sugammadex for effective and safe neuromuscular blockade and recovery, and supportive use of a fiberoptic bronchoscope for securing the airway.

Open Access Case Report

A Modified Technique for Repair of Triceps Avulsion Using Suture Anchors-A Case Report

A. Raviraj, Vidyasagar Maalepati, Ashish Anand

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2017/37121

The bony avulsion of the Triceps is a rare injury. The Triceps tendon injury accounts for <1% of all tendon injuries. Various surgical techniques have been described for the repair. We describe our variation of suture anchor technique for bony avulsion of Triceps injury and report its advantages.

Open Access Original Research Article

Headache Attributed to Acute Ischemic Stroke in Chinese Patients: A Single Center Study

Xiaoyan Chen, Hui Su, Mingjie Zhang, Zhiye Chen, Shengyuan Yu

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/37352

Aims: In this pilot study we aimed to investigate prevalence, characteristics and possible mechanisms of headache in acute ischemic stroke from a Chinese tertiary hospital.

Methodology: Five hundred and fifteen patients with acute ischemic stroke from Chinese PLA General Hospital were retrospectively investigated. Headache prevalence, features and correlations with several clinical parameters (age, sex, vascular risk factors, atherosclerosis, artery stenosis, infarct locations, presumed etiology according to TOAST criteria) were analyzed.

Results: Of 515 participants, 36 (7%) experienced headache during the acute event. Younger age, non-atherosclerosis and occipital lobe infarct were more associated with headache occurrence (P<0.05). Headache occurred mostly within one day before (41.7%) or simultaneously (47.2%) with other ischemic symptoms in a stroke. Most patients had tension-like headache. There is no significant correlation of headache location with infarct location.

Conclusion: Our study indicated that non-atherosclerosis cerebrovascular diseases and cortical spreading depression caused by occipital infarction might play a role in stroke onset headache. Headache may be a warning sign of stroke onset since most headaches occurred shortly before or simultaneously with stroke. Headache information needs to be fully recorded in prospective stroke registry.

Open Access Original Research Article

Screening Mammography Findings among Some Nigerian Women

A. O. Akhigbe, R. A. Akinola, E. O. Ighodaro

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2017/37132

Background: Screening mammography is currently the most effective and reliable Imaging method for early detection of breast cancer in women, when it is most treatable, thus reducing the health burden and mortality arising from breast cancer.

Objective: This study was to assess the findings on mammograms of women who came for routine screening mammography.

Design: A prospective descriptive multiple centre Study.

Setting: Sharon Radio- Diagnostic Centre, in Benin City and Lagos State University Teaching Hospital, Lagos. (LASUTH)

Subjects: All the 242 asymptomatic women who presented for screening mammography over a four year period (2010-2013).

Results: A total of two hundred and forty-two women were screened, and the mean age of the study population was 48.93+8.0 years with age range of 25 to 76 years. Majority of the women who came for mammography screening were in the 40 to 50 years age range, making up 60.7% of the study population and the predominant breast parenchyma pattern was scattered fibroglandular densities (56.6%).  Seven eight women making up 32.2% of the total population had positive findings on their mammograms, however only 7 women about 2.9% appeared significant and needed biopsy to rule out malignancy. Majority of the mammograms had BIRADS category 1 (52.5%), which implied nothing was found and so they were normal.  The Parenchyma pattern had statistically significant correlation with age (p<0.001).

Conclusion: The percentage of probably malignant findings was low in this study and better outcome is expected from such screening detected lesions.  Therefore effort should be made to encourage women to embrace screening mammography as a routine investigation, as its role in reducing breast cancer mortality cannot be overemphasized.

Open Access Original Research Article

Reflective Learning Experience in Primary Care Medicine Posting: A Potential Qualitative Study

Htay Lwin, Nan Nitra Than, Mila Nu Nu Htay, Htoo Htoo Kyaw Soe, Adinegara Lutfi Abas, Soe Moe

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/37225

Purpose: The purpose of this study is to determine the effects of reflection on learning during family medicine posting, to introduce a reflective writing exercise into an undergraduate medical curriculum, including their levels of satisfaction and their concerns.

Methods: We used the secondary data taken from the final year medical students’ feedback records during their one-week family medicine posting. The total number of 148 students’ reflective writings were collected. Among them, 52 students’ data (35% of total participants) who provided the full answers were included in the analysis. Qualitative analysis was done using RQDA (Free qualitative data analysis) software. Data were entered first in the notes and transferred to RQDA software as files. Codes and code categories were formed by using both pre-set code and emergent codes. Code categories were also pre-settled according to the objectives and the outcomes. We compared the reflective ideas of the students’ with the objectives.

Results: The qualitative analysis of the students’ reflection revealed four salient themes based on their learning experiences. They are (1) Learning and experiences at primary health care (KK) clinics, (2) Understanding the role of family medicine clinic and health care personals, (3) Benefits and drawbacks of Primary health care clinics for the patients and (4) positive attitudes and behavior towards family medicine services and staffs. Medical students’ responses to effects of reflection on learning are “enhanced their learning process and gain knowledge”, “improved their awareness about the common medical illness”, “improved their communication skills”, “improved their practical skills”, “applied their theory knowledge”, and “motivated them to become the efficient medical doctors in future”. There is a positive attitude on awareness of reflective writing, the role of importance of teamwork and good communication skills during the primary health care posting.

Conclusion: This qualitative study revealed the students’ achievement in learning through reflexion in problem solving, concept, and services of primary health care during their community clinic posting. In order to have the better understanding of primary health care services and provide the better care to the community in future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia.

Open Access Review Article

Lassa Fever in West Africa: A Clinical and Epidemiological Review

D. J. Omeh, G. I. Achinge, P. O. Echekwube

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2017/37171

Since 1969, when the first case of Lassa fever was documented in Lassa town, Nigeria, Lassa fever has assumed endemic proportion with yearly outbreaks in West African countries of Nigeria, Sierra Leone, Guinea, and Liberia; with devastating public health implications. Despite the progress made in recent times in understanding the replication pattern of Lassa fever and the breakthroughs in the pathogenesis and molecular epidemiology of Lassa virus, as well as the development of the appropriate technologies for early diagnosis of this highly virulent and contagious viral hemorrhagic disease, control of Lassa fever outbreaks has remained elusive in the West African sub-region.

This review article aims to provide the healthcare workers and other stakeholders with the needed comprehensive knowledge about Lassa virus, and the disease it causes, with emphasis on the control and preventive measures. The data for this review was gotten from analysis of research articles and surveillance reports on Lassa fever, using search engines such as Pub Med, Google Scholar, and department of health websites.

Ineffective control measures and non-availability of resources for early diagnosis and prompt treatment of cases were identified to be responsible for the frequent outbreaks and high case fatality rates. We made a case for international collaboration in the development of effective and affordable vaccine for Lassa fever.

Open Access Review Article

Clinical Features and Outcomes of Mycophenolate Mofetil-induced Diarrhea: A Systematic Review

Prajwal Dhakal, Rakesh K. Gami, Adams Kusi Appiah, Smith Giri, Harlan Sayles, Vijaya R. Bhatt

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2017/37412

Mycophenolate Mofetil (MMF) is an immunosuppressive drug frequently used for prevention of graft rejection in solid-organ and hematopoietic stem cell transplants. MMF-induced diarrhea is a known complication, however, details regarding its clinical manifestations, treatment options, and outcomes are less clear. Differentiating MMF-induced diarrhea from other causes of diarrhea in an immunocompromised host on the basis of histology may be difficult, hence deeper clinical understanding of MMF-induced diarrhea can be valuable. Our objective was to determine the clinical manifestations and outcomes of MMF-induced diarrhea. Major databases were searched to include 44 articles that provided data on 560 episodes of diarrhea induced by MMF or its derivatives.

Results depicted the median age of 45 years (range 8-70); 29% were females. The latency between use of MMF and onset of diarrhea was 990 days (range 12- 5760). Watery diarrhea was the presenting symptom in 98%. MMF was discontinued or dose reduced in 56%, switched to enteric coated mycophenolate mofetil sodium in 12%, and continued in 14%. Eighty-five percent of cases who were managed with discontinuation/dose reduction of MMF and 81% of cases who switched from MMF to enteric coated mycophenolate mofetil sodium responded. The median time to response for either change to enteric coated mycophenolate sodium or discontinuation/dose reduction of MMF was 20 days (range 1-120 days).

Thus, MMF-induced diarrhea generally presents with watery diarrhea, and a majority of patients respond to discontinuation or dose reduction of MMF within a few weeks. Where continuation of MMF is important, a different drug formulation may be an option.