Open Access Case Report

Giant Extracranial Carotid Artery Pseudo-aneurysm Causing Acute Airway Obstruction

B. I. Akhiwu, S. D. Peter, J. M. Njem, E. O. Ojo, I. O. Omofuma, A. G. Adewale, A. S. Adoga

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/43733

Aneurysms of the carotid artery are known to be very rare. When they occur, they can result in upper airway obstruction, vascular embolisation of blood clots, stroke, or other neurologic deficits. Most importantly if they do rupture, it may be fatal. The present study reports a 24-year old male with a carotid artery aneurysm initially misdiagnosed as tuberculous adenitis that later developed dyspnoea, dysphagia and hoarseness. He was managed using a multidisciplinary approach. Intra-operative findings showed a huge pseudo-aneurysmal sac, 14 cm ×12 cm, completely occluding the airway and filled with blood and clots. The sac was communicating with the mid medial aspect of the common carotid artery via a 0.7 cm longitudinal tear. He had surgery and excision of the aneurysmal sac measuring 12 cm × 14 cm and recovered with neuropraxia of the right hypoglossal nerve which subsequently resolved.

Open Access Original Research Article

Control Measures for Nosocomial Infections: Knowledge and Practice of Medical Students in a Nigerian Tertiary Hospital

V. U. Muoneke, N. C. Muoneke, S. J. Ekwu, A. F. Una, S. N. Uwaezuoke, C. N. Onwasigwe

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/44903

Background: The risk of acquiring nosocomial infections is high among hospitalised patients in developing countries. Exposure to hospital workers and medical students also renders them susceptible to these infections. Knowledge of control measures by these students is thus pertinent for both self-protection and limitation of infection spread.

Aim: The study was aimed to assess the knowledge of medical students in a Nigerian tertiary hospital of the control measures for nosocomial infections.

Methods: A cross- sectional study was conducted among medical students in Federal Teaching Hospital Abakaliki (FETHA), south-east; Nigeria between January and June 2016.

A 20-item structured, infection-control standardised questionnaires were administered to 221 students selected by systematic random sampling. The collected data were analysed for descriptive statistics using SPSS software package version 20 (IBM SPSS). The differences in proportions were tested for statistical significance using the Chi-square test. Statistical significance was based on p- value <0.05.

Results: Of the 221 medical students who participated in the study, the majority (62.9%) were males with a male: female ratio of 1.7: 1. The age range of the participants was between 19 and 50 years with a mean age of 24.98 ± 3.46. Approximately 96.0% and 68.3% of the study respondents had adequate knowledge of nosocomial infections and adequate knowledge of control measures respectively. The knowledge of these infections and their control measures as well as the practice of these measures were significantly influenced by the age and the academic level of the respondents (p= 0.001).

Conclusion: Higher-level medical students appear to be more conversant with the concept of nosocomial infections and their control measures. There is a need to initiate the subject early enough in the school curriculum as well as institute formal training. Establishment of strict rules is also necessary which will guide implementation of nosocomial infection control measures.

Open Access Original Research Article

Prevalence of Reported Symptoms of Musculoskeletal Disorders among Doctors at the University of Port-Harcourt Teaching Hospital, Nigeria

B. C. Ephraim-Emmanuel, K. E. Douglas

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/JAMMR/2018/45210

Background: Musculoskeletal system disorders are potential sources of occupational Public Health concern with worldwide prevalence. These disorders arise as a result of exposure to hazards related to biomechanical overload which adversely affects the body’s osteo-articular system. This study was to determine the prevalence of work-related musculoskeletal disorders and associated factors among doctors working at the University of Port Harcourt Teaching Hospital, Nigeria.

Methods: Following Ethical clearance, this descriptive cross-sectional study applied multistage sampling in selecting 223 consenting respondents. Data collection was via structured close ended self-administered questionnaire and a walk-through survey. Data were analysed and presented using descriptive and analytical statistics.

Results: Prevalence of work-related disorders of the musculoskeletal system was found to be 90.6%. The most common musculoskeletal disorder symptom was pain (88.6%). The most affected body site by these disorders was the lower limbs. Occurrence of the disorders was significantly associated with the rank (p=0.02) as well as the number of years of practice (p=0.033) of the respondents.

Conclusion: Prevalence of work-related musculoskeletal disorders was high among doctors at the University of Port Harcourt which was significantly associated with rank and years of practice. It is recommended that shift duties rosters are prepared with enough time available for break periods especially for junior doctor cadres.

Open Access Original Research Article

Patients' Perceptions and Satisfaction with Outpatient Healthcare Services in a Public Healthcare Facility: Results from a Patient Exit Survey in Ghana

Abdul-Malik Abdulai, Shamsudeen Mohammed, Osman Abu Iddrisu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/45003

Introduction: Patient satisfaction is commonly used as an indicator to measure the quality of healthcare. It embodies the patient's perceived needs, expectations, and experience of healthcare. The aim of this study was to assess patients’ perceptions and satisfaction with outpatient healthcare services at the Tamale Central Hospital in Northern Ghana.

Methods: This was a cross-sectional study conducted at the outpatient department (OPD) of Tamale Central Hospital in the Northern Region of Ghana. Purposive and convenient sampling methods were used to sample 385 outpatients. Exit interviews were conducted with a three-point Likert scale questionnaire. Chi-square test was used to assess the association between the overall satisfaction level and socio-demographic characteristics of the patients.

Results: Most, 169(44.9%), of the patients were in the age range of 18-30 years. The majority of the patients were satisfied with the physical environment at the OPD (n=293, 77.9%). The second highest satisfaction level was with provider interpersonal skills (n=216, 57.5%). However, only 42.3% of the patents were satisfied with the waiting and consultation times measured in this study. The overall patient satisfaction level based on the three domains measured in this study was 61.2%. The results demonstrated a statistically significant association between the overall satisfaction level and patient’s age (x2=17.2038, p=.001), marital status (x2=3.9209, p=.048), and educational level (x2=7.5089, p=.023).

Conclusion: Patients' satisfaction with outpatient healthcare services in the hospital could improve if the management of the hospital implemented interventions to minimise patient waiting time and improve the patient-provider relationship. Improved provider-patient ratio and proper filing of patients’ medical records could decrease patient waiting time at the hospital. Furthermore, we recommend in-service training and seminars on patient-provider relationship to enrich provider interpersonal skills as this have the potential to upsurge treatment compliance and improve health outcomes of patients.

Open Access Original Research Article

Clinico-laboratory Profile of Childhood Tuberculosis Admitted at a Tertiary Hospital in Nepal

B. K. Shah, S. K. Mishra

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/JAMMR/2018/45030

Aims: To describe the clinical and laboratory profile of children admitted with Tuberculosis at a tertiary care hospital in Nepal.

Study Design:  Retrospective study.

Place and Duration of Study: Department of Pediatrics, Patan Academy of Health Sciences, between April 2013 and April 2018.

Methodology: All childhood TB patients (age 0-15 years) admitted to Patan Hospital from April 2013 to April 2018 (5 years) were included in the study. Medical record files of the eligible patients were retrieved from the medical records section. Medical record files, reports of chest x-rays and laboratory investigations were reviewed and information regarding diagnosis and treatment of TB was filled in a pre-designed proforma. Collected data were entered and analysed in Statistical Package for Social Sciences (SPSS version 25.0) software.

Results: A total of 64 patients were admitted with the diagnosis of TB in the Department of Paediatrics at Patan Hospital from April 2013 to April 2018. The median age of the patients was 7.8 years, age ranging from 4 months to 15 years. Male to female ratio was 1.56:1. Extra-pulmonary TB (59.38%) was more common than pulmonary TB (40.62%). Fever (79.68%) was the most common presenting symptoms. Among extra-pulmonary TB, pleural effusion (39.47%) and abdominal TB (26.31%) were the most common diseases. TB meningitis was the least common disease, seen in only 3 patients.

Conclusion: Childhood TB is prevalent but underdiagnosed disease our setting. Extrapulmonary TB is more common in children, pleura and abdomen being the most common sites. Microbiological confirmation of TB in children is very low, so the diagnosis of TB in children largely depends upon clinical signs and symptoms along with supportive laboratory investigations.

Open Access Review Article

Human Immunodeficiency Virus Infection, Treatments, and Therapy: Effect of the CCR5 Mutation

Brittany Hurst, Meagan Maki, Frank Mallory, Kabwe K. Nkongolo

Journal of Advances in Medicine and Medical Research, Page 1-19
DOI: 10.9734/JAMMR/2018/45018

Since the beginning of the HIV epidemic, more than 70 million people around the world have been infected with HIV and about 50% of them have died. In 2016, globally, about 36.7 million people were living with HIV. The most common resistance to HIV infection is associated with a mutation on CCR5 co-receptors. Individuals who do not carry this natural resistance rely for survival on the antiretroviral therapy (ART) which is very costly and requires lifelong treatments. In addition to the Antiretroviral Therapy, other treatment methods are being developed. They include RNA and protein Interference methods and Hematopoietic Stem Cell Transplant methods. A common limitation of these methods is the potential health risks on patients being treated. Gene therapy would be a more efficient and sustainable approach of fighting this disease, in the absence of a cure.  Currently, the most studied option involves the modification of the CCR5 gene to prevent the entry of the virus.  The editing of this gene within the host’s DNA has been explored in three ways that include Zinc Finger Nucleases (ZFNs), Transcription Activator-like Effectors Nuclease (TALEN), and CRISPR-Cas9. This review is a critical analysis of progress made on HIV treatments and of studies pertinent to the chemokine co-receptor 5 and gene therapies.