Open Access Case Study

Anesthesia for Urgent Surgery in a Patient with Angioneurotic Oedema: A Case Report

Said Khallikane, Aziz Benakrout, Hanane Delsa, Mohamed Moutaoukil, Khalil Abou Elalaa, Samir Siah, Hicham Balkhi, Abdelouahed Baite

Journal of Advances in Medicine and Medical Research, Page 20-26
DOI: 10.9734/jammr/2020/v32i1930664

Hereditary angioneurotic oedema is an autosomal dominant disease associated with serum deficiency of functional C1-inhibitor. It is characterized by periodic swelling of subcutaneous tissues, abdominal viscera and upper airways. Lethal acute episodes of oedema can occur during anaesthesia and surgery. It is essential to prepare such patients before surgery. This article describes a case and the various preventive measures used to avoid acute episodes during anaesthesia for urgent surgery for mesenteric ischemia. In emergency situations where C1 inhibitor concentrate is not available, fresh frozen plasma (FFP) can be used as an alternative, as it also contains C1 inhibitor, corticosteroids, antihistamines, and epinephrine can be useful adjuncts but typically are not efficacious in aborting acute attacks. Prophylactic management involves long-term use of attenuated androgens or antifibrinolytic agents (Tranexamic acid).Their various indications are discussed.

Open Access Case Study

Complicated Boerhaave’s Syndrome Managed by Conservative Treatment

S. D. Peter, A. H. Shitta, J. M. Njem, E. O. Igoh, A. F. Ale, M. W. Isichei, E. O. Ojo, M. A. Misauno, B. T. Ugwu

Journal of Advances in Medicine and Medical Research, Page 61-65
DOI: 10.9734/jammr/2020/v32i1930671

Boerhaave’s syndrome is a full-thickness perforation of oesophagus associated with vomiting and/or severe straining. It is a severe condition with high morbidity and mortality; the outcome is dependent on early recognition, prompt and effective intervention. It commonly presents early with mediastinitis or pleural effusion. Though uncommon, it can present late with severe chest complications which are usually managed aggressively. The present study reports a 41-year old Nigerian man with Boerhaave’s syndrome who presented with left pneumohydrothorax who was successfully managed with chest tube thoracostomy drainage and parenteral nutrition.

Open Access Minireview Article

Physical Exercise as a Modulator of Oxidative Stress and Inflammation in Atherosclerotic Plaque

Matheus Ribeiro Bizuti, Débora Meneghel, Eduardo de Camargo Schwede, Laura Nyland Jost, Débora Tavares de Resende e Silva

Journal of Advances in Medicine and Medical Research, Page 36-44
DOI: 10.9734/jammr/2020/v32i1930666

Cardiovascular diseases are the leading cause of death and reduced quality of life worldwide. One of the main risks to the development of cardiovascular diseases is inflammatory diseases, which are related to oxidative stress, among them, atherosclerosis. Atherosclerosis consists of a process of chronic inflammation, in which the accumulation of lipids occurs in the subendothelial space of the tunica intima of large caliber vessels. This is due to the accumulation of fibrous elements and inflammatory cells. Thus, regular physical exercise contributes to improving the body's immune defenses, while modulating inflammatory processes. In addition, physical activity is responsible for increasing the production of antioxidant enzymes, increasing the synthesis of nitric oxide, decreasing oxidative stress and decreasing systemic inflammation. Thus, physical exercise directly changes the genesis of atherosclerosis.

Open Access Original Research Article

Gastrointestinal Bleeding Diagnosed by Capsule Endoscopy – A Change towards More Patients with Bleeding-related Drugs

Alexander Hann, Louisa Graf, Thomas Seufferlein, Eugen Zizer

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/jammr/2020/v32i1930662

Background: Video capsule endoscopy (VCE) is the standard procedure for a work-up of a suspected bleeding source after negative gastroscopy and colonoscopy. Popularity of this procedure increased in the last decade. In this work we aimed to identify the changes in patient characteristics and how those changes influence bleeding related findings. In particular the assumed higher risk of gastrointestinal bleeding of the new oral anticoagulants (nOAC) compared to phenprocoumon was of interest.

Methods: Consecutive VCE examinations performed at our center from January 2004 to March 2018 were identified retrospectively. Baseline characteristics of the patients, VCE results and treatment that was initiated were analyzed.

Results: 560 VCE were included in the analysis. The rate of VCE per month increased from 2.3/month in the period of January 2004 – December 2012 up to 5.0/month in January 2013 – March 2018. Accompanied by this increase the examined patients suffered from significantly more comorbidities (72 vs. 82%, p 0.001) and used a higher number of bleeding-related drugs (47 vs. 66%, p <0.001), especially nOACs. Age above 65 and bleeding-related drugs were significantly associated with angiodysplasias found on VCE examinations. NOACs and phenprocoumon showed no difference in their correlation to angiodysplasias.

Conclusion: This single center retrospective analysis revealed a steep increase in VCE examinations over the last years with an increase in the prevalence of comorbidities and the use of bleeding-related drugs. Interestingly, use of both nOACs and phenprocoumon did not result in a significant higher rate of angiodysplasias in the VCE.

Open Access Original Research Article

Rapid Assessment of Indirect Effect of Handwashing Campaign during COVID 19 Risk Communication and Community Engagement on Diarrhoea and Respiratory Illness among Children under Five in Jijiga Town of Somali Region of Ethiopia

Olusola Oladeji, Abdifatah Elmi Farah, Asli Hassan, Mohamed Ayanle, Yusuf Mohammed Ali, Yusuf Mohammed Ali

Journal of Advances in Medicine and Medical Research, Page 11-19
DOI: 10.9734/jammr/2020/v32i1930663

Aims: Diarrhoea and pneumonia are serious global public health problems affecting child survival especially in the developing countries. The study aimed to assess the indirect effect of hand washing campaign during COVID risk communication and community engagement on diarrhoea and respiratory infection among children under five.

Study Design: This was both cross sectional survey and retrospective chart review.

Place and Duration of Study: Jijiga Town of Somali Region, Ethiopia between November 2019 and 30th June 2020.

Methodology: Handwashing practices among the households and the reported number of diarrhoea and acute respiratory infection in the District Health Information System (DHIS) database 4 months before and 4 months during COVID 19 risk communication handwashing campaign was assessed and paired t test used to determine the effect of the campaign on diarrhoea and respiratory illness at a significant level of 5%.

Results: 255(44%) of the 580 households had basic hand washing facilities, however 171 (67.1%) of the 255 households with hand washing facilities demonstrated appropriate hand washing techniques. The percentage mean reduction in the number of children under five treated for acute respiratory infection and diarrhoea before and during the campaign was 6.49% and 11.5% though not statistically significant with p value = 0.778 and 0.3952 respectively.

Conclusion: The study reaffirmed the effect of proper hand washing practices on the reduction of episodes of diarrhoea and acute respiratory infection among children which ultimately will contribute to reducing child mortality and shows that COVID interventions and investment could be used to support and strengthen non COVID routine health services.

Open Access Original Research Article

The Locus of Fat Over-Accumulation as Predictor of Cardiometabolic Risks among Non Obese Normotensive Adults

Kolade Oladele Sharaye, Emmanuel Idia Eboh

Journal of Advances in Medicine and Medical Research, Page 27-35
DOI: 10.9734/jammr/2020/v32i1930665

Studies on Metabolic Syndrome (MS) have recently been narrowed down to fat over-accumulation but there is no consistency in the obesity requirements for any of the health risk scores and definitions, thus, the utility of anthropometric measures in cardiometabolic risks prediction among non-obese requires additional research. This cross sectional study assessed the relationships and predictabilities of visceral adiposity index (VAI) and Lipid accumulation product (LAP) for cardiometabolic risks among 174 non obese adults (91 males and 83 females) 35 - 70 years of age that was randomly selected for this study after their consent. Anthropometric evaluation included weight, height, hip and waist circumferences. BMI, Waist-height ratio and waist-hip ratio were calculated. Serum Triglyceride and High Density Lipoprotein measured in a 12 hour fasting condition (mmol/L) using standard laboratory techniques were recorded. The VAI and LAP scores were calculated using the gender-specific equations. Systolic blood pressure and Diastolic blood pressure were measured and MABP was calculated as: DBP + 1/3 Pulse Pressure (mm/Hg). The results showed significant correlations among LAP, VAI, WHTR, WHPR and BMI (p≤0.01). Multivariate correlations and regression analysis of measures of adiposity and MS features also showed that LAP had a greater impact on features of MS and superior to other adiposity measures in male and female (R2: 0.956; p≤0.01). In conclusion, this study shows that LAP is superior in predicting risks of lipid and visceral adipose over-accumulations than other measures of adiposity among non-obese adults. The use of LAP as an assessment tool for Risks of fat over-accumulations and its intervention among non-obese adults was suggested.

Open Access Original Research Article

Awareness and Attitude of the Population of Karachi towards Stigma Associated with Cancer

Burhanuddin Tahir, Akhtar Ali, Anshahrah Riaz, Zuleikha Yousuf, Sara Qadir, Nehal Waseem

Journal of Advances in Medicine and Medical Research, Page 45-50
DOI: 10.9734/jammr/2020/v32i1930668

Background: Cancer related stigma arises due to an amalgamation of certain myths, lack of understanding and religious and social beliefs that vary across different cultures. Despite the widespread availability of information regarding the characteristics of this disease and the ever-growing technological advances, cancer still remains a taboo with the cultural stereotype of its diagnosis being equivalent to a death warrant or penalty for unethical conduct.

Objectives: This research aims to assess the prevalence of cancer stigma in the general population of Karachi and explores the different perceptions and misunderstandings of people regarding cancer patients.

Methodology: It was a cross sectional study conducted at Ziauddin University from July to August 2020. The calculated sample size at 50% proportion was 385 and convenient sampling technique was used to recruit the required sample. Data regarding demographics was collected by a self-administered questionnaire and cancer stigma scale was used to identify the awareness and attitudes.

Results: n= 174 (60.8%) responded as yes. n=126 (44.1%) participants mentioned that their close relatives have suffered from cancer. When asked about cancer awareness most of the study participants seemed to be aware of diseases. However n= 115 (40.2%) responded that cancer ruins the life of the sufferer. When the participants were asked about cancer stigma, they disagreed and showed that they do not have any fear from cancer patients.

Conclusion: The population of Karachi was not having any stigma related to cancer and their attitude towards cancer patients according to the questionnaire seemed to be very positive and humanitarian.

Open Access Original Research Article

Preferred Learning Style and Study Characteristics among Undergraduate Clinical Medical Students: A Study in National Defense University of Malaysia

Sheikh Salahuddin Ahmed, Sagili Chandrasekhara Reddy

Journal of Advances in Medicine and Medical Research, Page 51-60
DOI: 10.9734/jammr/2020/v32i1930669

Purpose: Learning clinical science depends on the learning style and characteristics of the student as well as the learning environment and teaching characteristics. The aim of this study was to determine the preferred methods of learning style and study characteristics of undergraduate senior clinical medical students.

Methods: This study was conducted among 89 medical students of 4th and 5th year of the Faculty of Medicine and Defense Health, National Defense University of Malaysia, from 1st November 2019 to 31st July 2020. Each of the students was given a structured questionnaire for their responses to determine their preferred learning style and study characteristics.

Results: The mean age of the students was 23.5 years (range 23-27 years). A combination of various methods of learning style that included reading/writing, hearing, seeing (observing), and practicing of skills was used in 69.7% of students. Preference of learning from making and reviewing notes of class teachings was 98.9%; e-learning 53.9%; memorizing key features 71.9%; and silent study 94.3% of students. Learning by a discussion with fellow students was preferred by 65.2% and interactions in the class were preferred by 56.2% of students. Observing skill demonstration by a teacher was preferred by 77.5% of students. Learning of a clinical skill by practicing on a real patient was preferred by 94.4% of students. 

Conclusion: A combination of various learning styles is preferred by the majority of students for their learning. The students prefer to take and review class notes, study silently, use e-learning uploaded materials, interact in the class and learn a clinical skill by practicing on a real patient rather than simulated patients or mannequins. The preference of the student learning style and their choice should be taken into account for constructing teaching methods to achieve a better academic outcome.

Open Access Original Research Article

Laparoscopic Surgery in a Developing Country in East Africa: An Audit at the Initial Part of a Surgeons’ Learning Curve

Richard Wismayer

Journal of Advances in Medicine and Medical Research, Page 66-73
DOI: 10.9734/jammr/2020/v32i1930672

Background: In many surgical conditions, laparoscopic surgery has been used for surgical access. In the West, laparoscopic cholecystectomy is the gold standard treatment for           cholecystitis. On the other hand controversy has been generated with laparoscopic appendicectomy due to the cost, time consuming nature of the procedure, together with many trocar sites which in all approximate to the length of an open appendicectomy incision. The purpose of this study is to audit the initial laparoscopic units experience in a developing country in East Africa.

Methods: This was a retrospective study conducted in the Department of Surgery. All patients that consented to laparoscopic cholecystectomy and laparoscopic appendicectomy over the initial period of 13 months were included in this study.

Results: A total of thirty (30) patients consented to having laparoscopic surgery; Ten (10) patients consented to laparoscopic cholecystectomies with a male:female ration of 1:2.33 and twenty (20) patients consented to laparoscopic appendicectomies with a male:female ratio of 1:1.2. The mean operating time was 58.5 minutes for laparoscopic cholecystectomy and 40.45 minutes for laparoscopic appendicectomy. The duration of post-operative admission ranged from 3 days to 5 days with a mean duration of 4.2 days for laparoscopic cholecystectomy and from 2 days to 5 days with a mean of 2.65 days for laparoscopic appendicectomy. No complications were reported apart from spinal headache in 2 patients (2.6%) out of the total laparoscopic procedures. There were no readmissions over the one month of follow up.

Conclusions: Laparoscopic cholecystectomy and laparoscopic appendicectomy allows for early discharge and is safe. In Uganda, the low incidence of cholecystitis compared to the higher incidence of appendicitis, supports the adoption of laparoscopic appendicectomy compared to cholecystectomy for hand and eye coordination training. The surgeons’ initial cases of laparoscopic procedures have demonstrated an adequate level of safety which supports laparoscopic appendicectomy to acquire the basic laparoscopic surgery skills.

Open Access Original Research Article

Coronavirus Disease (COVID-19) Pandemic: Analysis of the Knowledge, Attitude and Practice among Healthcare Facilities in Jos, Nigeria

Maryam Shehu, Hassan Shehu, Abel B. Izang, Oseni Momodu, Abraham Owokolo, Sekyen Sana, Edwin E. Eseigbe

Journal of Advances in Medicine and Medical Research, Page 74-85
DOI: 10.9734/jammr/2020/v32i1930673

Background: COVID-19 which was first reported in Wuhan China is now a global pandemic. Healthcare workers play a significant role in fighting this pandemic. The aim of this study is to assess the knowledge, attitude and practice (KAP) of COVID-19 among healthcare professionals in Jos.

Methodology: The study population are all the health workers in Bingham University Teaching Hospital (BHUTH), Plateau State Specialist Hospital (PSSH) and ECWA comprehensive health care center (ECHC) in Jos who consented to the study. Consecutive sampling was employed in selecting eligible workers who consented to the study. Data generated was subjected to descriptive and inferential statistics as appropriate.

Results: There were 446 HCWs, in comparing the overall mean knowledge score regarding COVID-19 between the different cadre of clinical HCWs, the difference was significant (F= 5.23, p= 0.002). The overall mean knowledge score between the different cadre of non-clinical HCW was not statistically significant (F= 1.38, p= 0.26). There was no significant difference between the mean scores of KAP of the doctors in the different hospitals in Plateau State (F= 0.46, p= 0.63; F= 0.34, p= 0.71; F=0.41, p= 0.66) respectively. The result showed a significant association between job cadre with KAP.

Conclusion: The KAP of the HCW was good, however, there was a significant difference between the knowledge scores of the different cadre of clinical HCW in Plateau State. There was also a significant association between the different job cadre with KAP of the HCW.