Open Access Clinical Practice Article

A Modified Clinicopathological Conference as a Potential Learning Teaching Activity for Civilian and Army Medical Students and House Officers

Prameela Kannan Kutty, Muhamad Abu Bakar, Sagili Chandrasekhara Reddy

Journal of Advances in Medicine and Medical Research, Page 55-63
DOI: 10.9734/jammr/2020/v32i630433

The clinicopathological conference (CPC), a novel learning teaching activity, consciously integrates by clinical reasoning, to arrive at the final diagnosis of a selected case. This process traditionally involves case selection, presentation of the history and the clinical findings, interpretation of investigations, discussion of differential diagnoses with final diagnosis, followed by an energetic discussion of relevant aspects of the case and its management.

This article discusses a modified CPC, a potential educational activity for undergraduate medical students and house officers in general, with its conceptual ideas based on our pilot activity, contributing to the literature of the CPC because it highlights novel aspects of discussion used and indeed plausible, in our medical school that trains both civilian and army doctors. This academic exercise, involving preclinical and clinical specialists in a multidisciplinary environment uniquely incorporates other bodies that work together for patient care in a military hospital. The discussion embraces some views from personnel in charge of social work and administrators which could be furthered, enriching the holistic learning teaching experience of all attendees.

As the learning and teaching of medicine adapts to contemporary demands, sustained efforts and commitment from organizers and participants of such a discussion contributes constructively towards the advancement of medical education. The modified CPC as presented here is an innovative platform possibly emulated for flexibility of approach, content and delivery and for its potentials in the learning and teaching of young doctors and trainees.

Open Access Minireview Article

Additive Manufacturing: A 3-Dimensional Approach in Periodontics

Anurag Bhatnagar, Amit Bhardwaj, Shalu Verma

Journal of Advances in Medicine and Medical Research, Page 105-117
DOI: 10.9734/jammr/2020/v32i630441

Additive manufacturing technology or 3-dimensional printing has been used since ages in various fields including medical. Their addition to dentistry is recent and has tried to revolutionize the field. It is being used in various fields of dentistry like endodontics, prosthodontics, orthodontics, oral and maxillofacial surgery and recently in periodontics and Implantology. With introduction of recent “layer-by-layer” additive technology, their use in periodontal field has changed its treatment planning. It is use in preparation of customized scaffold with or without stem cell therapy, ridge augmentation, sinus lift and guided implant surgery, implant fixtures, education models, drug technology and many more. This review has tried to explain the various applications of the additive manufacturing in the field of periodontics with recent evidences. This paper highlights the role of 3-dimensional printing which can change the future of periodontal management.   

Open Access Original Research Article

Hyphal Formation is Enhanced by 121°C Heat Inactivation of Serum Added to Culture Media

Hong He, Xueting Wang, Congcong Li, Xiaotong Deng, Yan Fan, Jianxin Han

Journal of Advances in Medicine and Medical Research, Page 12-20
DOI: 10.9734/jammr/2020/v32i630427

Background: A novel method for inducing hyphae formation, was described.

Methods: Mycelia of experimental and clinical strains from 100 patients with oral lichen planus were cultured in RPMI 1640 medium with 56°C or 121°C inactivated calf sera. After these strains were cultured for 2 h to 7 days, the average hyphae formation rate was observed under light microscopy.

Results: The 121°C inactivated calf serum showed better outcomes than 56°C inactivated calf serum in terms of time and amounts of hyphae products.

Conclusions: For Candida albicans hyphae culture, the 121°C inactivated serum is superior to the 56°C inactivated serum.

Open Access Original Research Article

Role of Clinical Electives on Academic Career: A Cross Sectional Study

Sajjad Ali, Anjuli Devi, Raja Azhar Humera, Muhammad Taha Sohail, Fizza Saher, Jabbar Ahmed Qureshi

Journal of Advances in Medicine and Medical Research, Page 21-26
DOI: 10.9734/jammr/2020/v32i630428

Introduction: Clinical Health Electives are an important part of academic curriculum in medical universities throughout the world. Electives are useful in developing personal and professional growth among students. Hence understanding the importance of electives among medical undergraduates on their academic life is important.

Materials and Methods: A cross-sectional based study was conducted among medical undergraduates in Karachi, Pakistan. A total number of 300 students from 3rd, 4th and 5th year of MBBS were taken as a sample. Consent was taken from the participants and questionnaire was filled from everyone. Study population was selected who did at least one clinical elective in their whole academic period.

Results: According to our analysed results, undergraduate students from both private and public sector medical institutes perceived clinical electives as an advantage to themselves. Majority of the students saw their clinical and academic performances to be on a higher level. This shows that opting for electives regardless of its type (local or international) have proven to be fruitful for the undergraduates’ personal growth and academic career, allowing more scope for understudies to practice and enhance their skills they have only done a limited number of times, which inevitably leads to a steep learning curve.

Conclusion: There was a positive influence of clinical electives observed among the students. Overall the academic and clinical performance of the undergraduates enhanced by opting clinical electives and has positive impact on them.

Open Access Original Research Article

Evaluation of Adhesions Underneath Laparoscopic Sterilization Scar in Patients Undergoing Abdominal Surgery

Ravi Singh Dogra, Sanjeev Kumar, Som Raj Mahajan, Rajesh Chaudhary, Poonam Dogra, Vikrant Dharwal

Journal of Advances in Medicine and Medical Research, Page 27-32
DOI: 10.9734/jammr/2020/v32i630429

Introduction: The minimally invasive approach has become the method of choice for treating most benign abdominal diseases that require surgery. However, it is obvious that laparoscopic procedures are not risk free. The aim of this study was to evaluate the prevalence of intra abdominal adhesions underneath umbilical scar following laparoscopic sterilization, in patients who are undergoing abdominal surgeries.

Materials and Methods: The present study was a hospital based prospective observational study conducted in the Department of Surgery, Dr Rajendra Prasad Government Medical College (Dr. RPGMC), Kangra at Tanda (HP). The study group consisted of patients admitted to department of surgery during a period of one year and who fulfilled inclusion criteria. During intraoperative period, they were examined for presence or absence of adhesions at the site of previous laparoscopic sterilization scar at Periumblical area.

Results: Total of 60 patients were taken in this study. Two out of 60 (3.3%) patients had adhesions underneath previous Laparoscopic Sterilization scar around umbilicus and adhesive structure was omentum in both cases.

Conclusion: Adhesion formation is expected in any abdominal surgery whether open or laparoscopic surgery. In our study only 3.3% of patients had adhesions underneath previous laparoscopic sterilization scar in periumblical region. Therefore umbilical port can be considered for re-entry of index port in next laparoscopic surgery, in patients with history of laparoscopic surgery through umbilical region.

Open Access Original Research Article

Effect of Antiasthma Medication on Blood Eosinophil Count and Serum Immunoglobulin E Levels: A Randomized Controlled Study

Wasim A. Wani, Sheeraz A. Dar, Khalid M. Kawosa, Mudasir Nazir, Ikhlas Ahmad, Asif Ahmed

Journal of Advances in Medicine and Medical Research, Page 33-39
DOI: 10.9734/jammr/2020/v32i630430

Background: Asthma is a chronic inflammatory condition of lung airways resulting in episodic airflow obstruction.

Aims: The main objective of this study is to find the effect of antiasthma medication on serum IgE levels and blood eosinophil count.

Study Design: This randomized controlled trial study was performed in children aged 6-15 years of age, with clinically stable and moderate persistent asthma.

Results: The findings of this study indicate both group (Budesonide/formoterol group and budesonide group) patients experienced a significant decrease in serum IgE levels and blood eosinophil counts over the study period. However, the difference in two groups was not statistically significant.

Conclusions: Inhaled steroids are effective in controlling systemic inflammation in asthma as evidenced by a decrease in IgE levels and eosinophil counts. However addition of LABA doesn’t have any additive effect.

Open Access Original Research Article

3-in-1 Block with Bupivacaine VS Bupivacaine Plus Dexamethasone in Acute Pain Control for Patients Undergoing Hip Nailing Surgery: A Double Blind Randomized Controlled Trial

Afshin, Amini, Arash, Farbood, Seyed Masoud, Hashemi, Mehrdad, Taheri, Amin Reza, Khaledi, Saman, Asadi

Journal of Advances in Medicine and Medical Research, Page 40-46
DOI: 10.9734/jammr/2020/v32i630431

Background: Femoral 3-in-1 block is one of the most effective methods in cases of hip nailing surgery because of its ease, low cost, and fewer complications. This study aims to evaluate the effect of adding dexamethasone to peripheral nerve block solution.

Methods: Forty-four ASA (I,II & III) patients aged between 50-80 years, scheduled for elective hip-nailing surgery who met inclusion and exclusion criteria were enrolled in this double blind randomized controlled trial. Patients were allocated into two groups randomly; at the end of the surgery, femoral 3-in-1 nerve block was performed with 40 ml of bupivacaine 0.25% solution with or without 8 mg dexamethasone. Pain score was measured for 24 hours.

Results: We found no significant difference in pain intensity scores until hour 0.5 and the scores were below 1. Thereafter, the VAS scores increased, yet it remained below 3 in the first 12 postoperative hours. Morphine was administered during hours 12-24 in both groups, when VAS scores reached to about 4. The total amount of morphine consumption was a little lower in the case group, although the difference was not statistically significant.

Conclusion: Adding dexamethasone to bupivacaine 0.25% for 3-in-1 block has no more benefit than bupivacaine 0.25% alone for acute postoperative pain management after elective hip nailing surgery.

Open Access Original Research Article

Orthodontic Pain and Patients’ Quality of Life: Patient Experiences and Provider Assessments

Sanam Tauheed, Erum Behroz Khan, Zafar Islam, Shoaib Khan, Saima Akram Butt, Attiya Shaikh, Mubassar Fida

Journal of Advances in Medicine and Medical Research, Page 47-54
DOI: 10.9734/jammr/2020/v32i630432

Objectives: To compare orthodontic pain and its Influence on quality of patient’s life as perceived by them with that assessed by their orthodontic care providers.

Materials and Methods: It was crosses sectional study involving 75 patients attending the orthodontic clinic and14 orthodontic care providers from September to October 2010. Patients aged 16 and older, receiving fixed orthodontic treatments were included. Patients and orthodontists scored pain during different orthodontic procedures using a qualitative pain intensity scale which graded pain for different orthodontic procedures. Oral health related quality of life (OHRQoL) was assessed by means of a 4-point likert scale to measure the influence of orthodontic treatment related pain on different aspects of life.

Results: For change of consistency of diet (p=0.02) statistically significant difference was observed between mean ranks of patients and orthodontists. For pain during record taking, higher mean ranks were reported for patients aged between 20-30 years (p = 0.01) whereas for pain after separator placement, patients aged above 30 had higher mean ranks (p = 0.05).

Conclusions: Orthodontists can accurately estimate the degree of pain their patients’ experience.

Significant proportions of patients experience substantial degrees pain during the visits, subsequent to orthodontic visits and pain due to fixed orthodontic appliance therapy transiently affects patients’ OHRQoL.

Open Access Original Research Article

Correlation of Quick SOFA Score and Procalcitonin with Mortality in the Emergency Department

Mandip Singh Bhatia, Ritu Attri, Kumar Rajni Kant, Saurabh C. Sharda

Journal of Advances in Medicine and Medical Research, Page 64-69
DOI: 10.9734/jammr/2020/v32i630434

Introduction: Sepsis is defined as life-threatening organ dysfunction caused by the dysregulated host response to infection with high mortality. Early diagnosis and treatment can decrease mortality.

Methods: We studied 2031 patients presenting to an emergency department with fever or suspected infection to find the correlation between q SOFA SCORE and procalcitonin levels with mortality.

Results: It is seen that mortality is directly proportionate to qSofa score and we also found that the value of procalcitonin is directly proportionate to qSofa score.

Conclusion: Combination of qSofa score with procalcitonin is a sensitive marker of death in sepsis. qSofa score of 2 or more is associated with increased mortality but its, not death sentence if all such patients treated aggressively & timely then the majority of them would survive.

Open Access Original Research Article

To Determine the Effect of Sleep on Anxiety, Depression and Its Correlation with Academic Performance in First M.B.B.S Students

Vinita H. Belsare, Sarika C. Munghate, Sanjay Agrawal, Hrishikesh Belsare

Journal of Advances in Medicine and Medical Research, Page 70-76
DOI: 10.9734/jammr/2020/v32i630438

Introduction: Sleep deprivation causes serious health hazards. Anxiety and depression are common correlates found. There had been direct correlation with sleep quality and academic performances.

Objectives: To determine the effect of sleep on the mental health i.e.  anxiety and depression among the first year medical students and also to see the effect of sleep, anxiety and depression on academic performance.

Methods: A cross sectional study was conducted at Medical college, Questionnaire was asked regarding the time to fall asleep and duration of sleep. Hamilton’s anxiety scale and Hamilton’s depression scale was applied to the study group.

Results: Mild anxiety (83%) is common than the depression (20%) in study group which may be the result of academic stress. The study also demonstrate severity of anxiety and depression goes hand in hand. The result also shows, depression and anxiety have indirect relationships with the duration of sleep that is as sleep hours decreases the anxiety, and depression score increases. The anxiety and the depression score were higher in the students who’s timing to sleep was after midnight, but the difference was not statistically significant as compared to the students who’s timing to sleep was before midnight. The study finding related to sleep and the academic score was not significant.

Conclusion: Bed time may not affect the mental health but the duration of sleep is important to reduce the level of anxiety and depression. Duration of sleep may not affect the academic performance, but sound and adequate sleep is important for the mental health which may ultimately affect the academic performance.

Open Access Original Research Article

Spectrum of Disease Conditions Seen at the Gastroenterology Clinic of a Tertiary Health Facility in South-Western Nigeria

Oguntoye Oluwatosin Oluwagbenga, Yusuf Musah, Olowoyo Paul, Soje Michael Osisiogu, Oguntoye Oluwafunmilayo Adenike, Oguntade Hameed Banjo, Ariyo Olumuyiwa Elijah, Atolani Segun Alex, Talabi Olukayode Abiola, Ogunmola Toba Osiron

Journal of Advances in Medicine and Medical Research, Page 77-87
DOI: 10.9734/jammr/2020/v32i630437

Background: Globally, gastrointestinal medical conditions are common and a considerable number of patients will require specialist consultation for the diagnosis, management and follow-up care.

Aim: To determine the spectrum of disease conditions seen at the Gastroenterology clinic of Federal Teaching Hospital, Ido-Ekiti in south-western Nigeria.

Methods: This was a retrospective cohort study of all patients who attended the Gastroenterology clinic between January 2015 and December 2019 (a period of 5 years). The Age, Gender and Diagnosis were obtained from the Clinic Register. A total of 679 patients attended the clinic over the period and they were all recruited into the study. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics used included frequency tables, means and standard deviations.

Results: A total number of 679 patients attended the Gastroenterology clinic during the period under review out of which 353 (52.0%) were males and 326 (48.0%) were females with a male to female ratio of 1.08 to 1. The age range of the patients was 10 to 93 years with a mean (±SD) of 43.8 (±16.32) and median of 40.0 years.

The commonest medical condition seen at our clinic was Chronic Hepatitis B viral infection (38.1%), followed by Acid Peptic Disorders (27.0%), Liver cirrhosis (5.2%), Non-Alcoholic Fatty Liver Disease (5.0%) and Hepatocellular carcinoma (4.1%). Hepatocellular carcinoma was the commonest malignancy seen at our clinic followed by Gastric cancer (2.5%), Colorectal cancer (1.9%) and Cholangiocarcinoma (0.7%). Pancreatic cancer and Oesophageal cancer were seen at our clinic at the same frequency (0.6% each). Primary Biliary Cirrhosis, Achalasia and Irritable Bowel Syndrome were the least frequently seen (0.1% each) medical conditions at our clinic. Acute Hepatitis B viral infection constituted 2.9% while Chronic Hepatitis C viral infection constituted 2.4% of the cases seen. The other medical conditions seen at our clinic include Alcoholic Liver Disease (2.4%), Abdominal Tuberculosis (0.7%), Toxin-induced Hepatitis (0.6%), Haemorrhoids (0.6%), Ulcerative Colitis (0.4%) and Diverticular Disease (0.3%).

Conclusion: The commonest medical condition seen at our Gastroenterology clinic was Chronic Hepatitis B virus infection followed by Acid Peptic Disorders both of which are largely preventable and the commonest malignancy seen at our clinic was Hepatocellular carcinoma. Hepatitis B virus infection is highly prevalent in our environment and it is a risk factor for chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Efforts must be enhanced by all stakeholders to curb the spread of this virus and thereby limit its sequelae.

Open Access Original Research Article

Histopathological Spectrum of Hysterectomy Specimens

Anil Kumar Gupta, Isha Gupta, Anil Kumar Suri

Journal of Advances in Medicine and Medical Research, Page 96-104
DOI: 10.9734/jammr/2020/v32i630440

Aims: Aim of this retrospective study, was to analyze the histopathological spectrum among women who have underwent hysterectomies at our institution.

Study Design: All hysterectomies were included in this study. Except 7 vaginal hysterectomies, all were abdominal hysterectomies. Clinical history and other relevant data were obtained from the records of Department of Pathology of medical college hospital. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined and analysed for histopathological diagnosis.

Place and Duration of Study: Study was conducted at NC medical College, Panipat India during calendar year 2019.

Methodology: A total of 480(n=480) hysterectomies received during the study period. Mean age of the patient was 40.02 years ranging from 30 to 66 years. 176 (36.5%) hysterectomy specimens did have unilateral salpingo-oophorectomy and 51 (10.6%) with bilateral salpingo-oophorectomy.

Results: Histopathologically, most common findings in hysterectomy specimens were chronic cervicitis in 396(82.5%), uterine fibroids in 251 (52.29%), adenomyosis in 24(5.0%) and endometrial hyperplasia in 18(3.75%). A total of 144 patients (30.0%) showed corpus luteum in their ovaries; of which cystic changes occurred in 28 (5.8%) and hemorrhagic luteal cysts in 13(2.70%) patients. Fallopian tubes, were pathologically unremarkable; 7(1.45%) patients had paratubal cysts. Ovarian neoplasms were accounted for only 1(0.2%) patient.

Conclusion: Histopathological diagnosis in present study were of benign in nature, requiring no further treatment and management beyond hysterectomy. Hysterectomies were performed in patients to improve the quality of life, to alleviate symptoms and occasionally as a life-saving measure.

Open Access Original Research Article

Ultrasonogram in Acute Appendicitis, A Surgeon’s Perspective: Original Article

Amar Verma, Rajesh Chaudhary, Ramesh Bharti, Kulbhushan Sharma, Rajesh Sharma, Vikrant Sharma

Journal of Advances in Medicine and Medical Research, Page 118-125
DOI: 10.9734/jammr/2020/v32i630442

Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same.

Materials and methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay.

Observations: It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/- 14.4 years. Mean hospital stay was 3.68 +/- 2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients.

Conclusion: USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.

Open Access Review Article

Colorectal Adenocarcinoma in East Africa: A Narrative Literature Review

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/jammr/2020/v32i630426

This paper is a review of work done on colorectal adenocarcinoma in East Africa showing geographic spread, age and sex ratios, clinical presentation, management and predominant histopathology. A steady increased incidence of CRC in East African countries is currently being documented however this is associated with a higher CRC-associated morbidity and mortality. Whilst the male: Female ratio varies between 1.2:1 to 1.88:1, up to 38% of CRC diagnosis are in patients younger than 40 years, in contrast to only 1.9% of CRC patients in Western developed countries such as the USA. Generally rectal carcinoma is more common than colon carcinoma and abdomino-perineal resections are commonly performed in up to between 54% - 71% due to the advanced stage of presentation of rectal tumours in East Africa. The late stage presentation and delayed effective treatment in East Africa may result in a higher morbidity in CRC patients. Interestingly there is a significant incidence of mucinous adenocarcinoma sub-groups compared to Western developed countries which carry a poor prognosis. A significant proportion of CRC patients have been found to have histological and demographic features which suggest that MSI-tumours and these tumours are more common in younger patients. However only a few authors have looked at the possibility of mismatch repair mutations in the genetic aetiopathogenesis of colorectal adenocarcinoma in East Africa.

Open Access Review Article

Biological and Comorbidity as Risk Factors for COVID 19 High Morbidity and Mortality among the Aged Population and Its Implications for Public Health Education and Research in Ghana

Albert Opoku, Joseph Sarfo Antwi, Abdul Karim Boakye Yiadom, Joana Owusu Danso, Prince Twene

Journal of Advances in Medicine and Medical Research, Page 88-95
DOI: 10.9734/jammr/2020/v32i630439

Introduction: The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) has been found to be the cause of this current pandemic of corona virus infection (COVID 19), (World Health Organization (WHO) 2020). It is of interest to note that Wuhan, which is located in the Hubei province of China, was the first community within which this outbreak was first identified in December 2019. There is high morbidity and mortality among the elderly patients with COVID-19 than the young and middle-aged patients. Again, most of the morbidity and mortality have comorbid conditions (presence of more than one disease in one person) from 1 to 3 in addition to COVID 19 and most of these conditions are age related.

Objective: The aim of this work is to describe changes in biological processes in aged population in relation to the presence of a possible comorbidity vis-à-vis COVID 19. To review publications and other studies associated with biological changes in the ageing process as well as identifying some specific comorbidity among the aged. To develop an appropriate health educational programs to protect the aged population on COVID 19. To develop an educational strategy on COVID 19 for the aged and the general public.

Methodology: The LILACS-BIREME, SCIELO, PUBMED, ACADEMIA, SCIENCE DOMAIN databases and some textbooks were consulted for the study. Scientific papers published English between January and March, 2020 on the subject of COVID 19 among the aged were selected for inclusion. A total 65 of studies published between January 1st, 2020 to March 30th, 2020 and some textbooks on Anatomy and Physiology were identified and evaluated. Twenty-seven (27) articles meeting the inclusion criterion (COVID 19 among the aged) were selected for this review. Finally, an analysis was conducted and the papers were assessed in agreement with the study objectives.

Results and Discussion: The studies reviewed discovered a high prevalence and mortality of COVID 19 among the aged with comorbidity due to deterioration in ageing process in Respiratory and the Immune systems.

Conclusion: It is recommended that some further research be done locally on COVID 19 to increase the knowledge on this subject in Ghana. It is also recommended that an appropriate health educational strategy be developed to create awareness among the aged.