International Journal of Medical Research & Review (IJMRR)
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Characteristics of polyps in Lebanese population
Full text linkBackground:
The objective of this study is to describe characteristics of the polyps in Lebanese population and evaluate the dysplasia and its relation to the polyps’ locations.
Methods:
Retrospective descriptive study was conducted at the Department of National Institute of Pathology in Lebanon and comprised biopsy of colonic polyps or resected polyps from patients from 2007 to 2009. We collected demographic data and polyps’ characteristics. Then, we divided patients according to age sex, location, histology.
Results:
With 2298 polyps in 1470 patients, the mean age was 57.45 with 68% aged more than 50yo. 75.6% have one polyps and multiple polyps more commonly found in older patient (> 50 years). More than 20 % of polyps found in the recto-sigmoid area. In the right colon, people older than 50 years were more likely to have polyps (19%) compared to those < 30 years (8.3%) (p < 0.05). In the rectum, people < 30 years were more likely to have polyps compared to those > 50 years (p < 0.01). Concerning the histology, tubular adenoma is the most common type and more prevalent in left colon. Hyperplastic polyps mainly found in the recto-sigmoid area and mainly in age group 30-50 in contrast to adenomatous polyps found over 50yo. Adenocarcinomas and/or degenerative polyps were founded in 5.9% of our population.
Conclusion:
This study gives valuable information on colorectal polyp in Lebanese population about age, sex, dominant histology and anatomic location. We noted a male predominance and mainly above 50 years old. The majority had single polyps, >50% of polyps were localized in the recto sigmoid. Adenomatous polyps were the most common type
Monitoring And Evaluation Of Adverse Drug Reaction In Emergency Medicine Department: A Prospective Observational Study
Full text linkBackground: Any deviation from the intended beneficial effect of a medication results in a drug related problem. Adverse drug reactions (ADRs) are negative consequences of drug therapy. It is the fourth to sixth leading cause of mortality in the United States of America.
Aims: To find out the proportion of medical emergency admissions that are secondary to Adverse Drug Reactions(ADRs).
Settings and Designs: An observational, prospective study conducted at the Emergency Medicine Department, at Tertiary Care Teaching Hospital for 12 months, daily from 9 am to 5pm.
Materials and Methods: Patients aged ≥ 18, who have given a written informed consent were included and patients not able to give willing consent and women presented with pregnancy were excluded in the study. The data was recorded in the case record form, The causality assessment was performed using WHO causality assessment scale. To determine the ADR severity, Modified Hartwig and Siegel scale was used.
Statistical Analysis: The statistical evaluation was done with the help of Statistical Package for Social Science (SPSS) version 21.0 manufactured by IBM (demo version) and Microsoft Excel 2016. p< 0.05 was considered as statistically significant.
Results: Elderly patients were having higher incidence of ADRs. Among all drug groups, the highest incidence were antimicrobials and drugs acting on blood. Majority patients either recovered or were in a recovering phase. Most of the ADRs were not preventable.
Conclusions: Reporting of ADRs in a systematic way allows appropriate analysis and intervention which will improve the patient’s safety. Many ADRs could be preventable by avoiding certain drug/drug combinations, hospitalization, dose dependent side effects, appropriate individual dosing and applying the Antimicrobial Stewardship Programme.
Keywords: Adverse Drug Reactions(ADRs), Antimicrobials, Emergency Medicine Departmen
ORTHODONTIC MARVEL: 2X4 APPLIANCE FOR IMPACTED INCISOR TRACTION - A CASE SERIES
Full text linkImpacted incisors can pose significant esthetic and functional challenges for patients. Various treatment approaches have been proposed. The 2x4 orthodontic appliance is one of the most effective treatment plans for aligning the teeth. This article presents two cases showing surgical traction\u27s effectiveness using the 2x4 orthodontic appliance in managing impacted incisors. The results of this case series demonstrated successful outcomes in terms of impacted incisor alignment and overall occlusion. Patients exhibited improved esthetics and function. Therefore, Surgical traction of impacted incisors using the 2x4 orthodontic appliance can be a viable and effective treatment approach. 
Histopathological Changes in Endometrial Biopsies of Patients with Abnormal Uterine Bleeding
Full text linkIntroduction: Abnormal uterine bleeding (AUB) is one of the commonest complaints leading to endometrial sampling by endometrial biopsy or curettage. Histopathological analysis revealed various patterns ranging from normal endometrium to malignancy and histopathological examination helps in the diagnosis of these diseases presenting with abnormal uterine bleeding. Objective: To assess the causes of AUB in reproductive, perimenopausal and menopausal women. Methodology: This is a retrospective study that includes a total of 375patients’specimens of endometrial biopsies which were clinically diagnosed as AUB in the department of pathology, faculty of medicine, the university of Benghazi from January 2009 to March 2010. The age of the patient ranged from 20 -80 years, and the mean age was (47.38yr). The patient was categorized into 3 groups with 198 cases in the perimenopausal age group,103 cases in the postmenopausal age group and only 74 cases in the reproductive age group. Results: in this study, the prevalence of non-neoplastic endometrial change was commonly seen in the perimenopausal and reproductive age groups (58.2%), (26.8%) respectively, whereas few cases in the postmenopausal age group (15%). The neoplastic endometrial changes (benign, premalignant, malignant) were commonly seen among the perimenopausal age group, followed by the postmenopausal age group, while neoplasia was rare in the reproductive age group. Conclusion: The causes of AUB depend on the age of the patient. In the reproductive age group, AUB was due to hormonal imbalance, while in perimenopausal and postmenopausal women it was generally due to hyperplasia and malignancy
Acute liver failure in an Immunocompetent host:A Diagnostic Dilemma
Full text linkAcute liver failure(ALF) is defined as acute onset of hepatic dysfunction with timing of 8-28 days between onset of jaundice and hepatic encephalopathy .It is a medical emergency which needs prompt diagnosis and appropriate management with identification of the aetiological factors.
I present an interesting case of acute liver failure due to cytomegalovirus(CMV) hepatitis in an immunocompetent, non addict patient without any co morbidities .The patient recovered with supportive treatment and did not require anti viral therapy as he was not immune compromised.
The importance of the case lies in the fact that viral hepatitis by CMV can present in immune competent patients also and other treatable causes of acute liver failure should also be identified as several patients of ALF may need liver transplantation
A A TALE OF TWO MALE SLES
Full text link SLE is an autoimmune disease with multisystem manifestations. SLE is more common in females typically beginning in the childbearing years suggesting a role for both hormones and as yet uncharacterized sex-related factors in the disease pathogenesis. The prevalence of the disease being one male patient for every 8-15 patients, the disease manifestations in male patients are considered to be graver than in females. Here is a case reporting of two males who came with different presentations of SLE , the first patient presented with rash,fever,alopecia,and arthralgia of small joints , the second patient presented with fever, easy fatiguability ,generalised edema ,breathlessness on exertion .Both of them were evaluated and found to have strong positive for ANA and ds DNA and EULAR ACR criteria for SLE was applied and both were diagnosed as SLE .They were treated with steroids and other immunosuppressants .Clinical improvement was noticed in both patients
Treatment of benign bone tumors: judicious use of adjuvants result in better functional outcomes
Full text linkBackground: While curettage has been a common treatment option for low grade benign lytic bone lesions, a careful extension of curettage enhances it’s efficacy without compromising the integrity of surrounding normal bone. Many adjuvants are used for extension of curettage, but all are not universally available, and each has it’s own drawbacks. We report outcome of extended curettage of benign lytic bone lesions using high-speed burr, electrocautery, hydrogen-peroxide, and pulsatile lavage.
Methods: The study was conducted on 25 patients,10 to 40 years in age, with lytic bone lesions proven benign. Tumors belonged to Campanacci Grade 1 and 2 of varying histological types. High-speed burr, electrocautery, hydrogen-peroxide, and pulsatile lavgage were extensively used after curetting the lesions with sharp curettes. Defects were filled with bone graft or substitute where needed, if the cavity size was more than 1/3rd of the width of the bone on radiographic assessment. Patients were reviewed for minimum 18months.
Results: All defects reverted to near-normal radiological appearance with excellent functional outcome recorded in most cases. Eighty percent patients recovered uneventfully. Mild limited complications were noted as prolonged period of pain in 12% and superficial infection in 8%. No local recurrence was observed.
Conclusions: This study demonstrates the efficacy of extended curettage in treatment of benign tumors and tumor like lesions of bone using simple cheap modalities which are universally available. In properly selected cases of benign bone tumors, a meticulously performed extended curettage provides an effective treatment option that safeguards functionality without compromising on safety
Communication difficulties and alternative ways for effective communication in critically sick patient in ICU
No full textInability to communicate can be a distressing problem for the patient who may be unable to speakbecause of the use of the paralyzing drugs or the endotracheal tube. Communication is the essenceof human life. Communication difficulties in intensive care units (ICU) with critically ill patients havebeen well documented for more than three decades. Critical care nurses provide a high level ofskilled nursing for total patient care and often facilitate communication between all of the peopleinvolved in the care of the patient. As part of any procedure, the nurse should explain what willhappen to the patient when the patient cannot speak. The nurse should explore alternative methodsof communication including the use of devices such as picture boards, note pads, magic slats, orcomputer keyboards when speaking with the patient. The nurse can assist the patients and familywith their feeling of anxiety by encouraging them to express concerns, ask questions, and state theirneeds.
Methods: For the present review article collected a database from studies that reportedcommunication difficulties with patients admitted in intensive and critical care units because ofmechanical ventilation, tracheostomy, paralyzing drugs or invasive procedures, and studies relatedto methods of improving communication strategies for the patient in the critical care unit.
Result:Results suggests that most alternative methods of communication were effective in improvingpatient satisfaction, decreasing patient frustration and facilitating communication. This review articleis aimed that critical care nurses assessing communication needs; identifying appropriate alternativecommunication strategies; create a customized care plan with the patient, the patient’s family, andother health care team members. The present review article focuses on the importance of effectivecommunication between critical care nurses and patients and between all of the people involved inthe care of the patient
Challenges in managing pubic ramus fractures Routine Computed Tomography for all pubic ramus fractures- Is there a role?
Full text linkPelvic fractures are amongst the most common fragility fractures sustained by the elderly patient from falling from a standing height. There are significant complications arising from this type of fracture, ranging from the patient with haemodynamic compromise with an unstable pelvis to a patient with minimal displaced pelvic ring fracture without compromise. In this article, we aim to highlight those patients who may have had an innocuous injury but cannot mobilise despite analgesic optimization. There are currently two strategies undertaken with immediate CT imaging in all patients sustaining pelvic fractures at admission and delayed CT imaging for those patients who cannot mobilise. The main aim of imaging is to exclude the presence of a posterior pelvic ring injury and exclude any vascular injuries in the haemodynamically compromised patient
Overlap syndrome of systemic lupus erythematosus and rheumatoid arthritis (“rhupus”) with systemic involvement – A rare case report
Full text linkA 43 year old female, known hypothyroidism, presented with chest pain, breathlessness, without fever or rash, since 15 days. She had multiple joint pains since 11 months. Distal interphalyngeal joints were spared. She had hand deformities and tenderness in the metacarpophalyngeal and proximal interphalyngeal joints of all 10 fingers and both hips and knees. 2D-echo showed Pulmonary Hypertension. High resolution computed tomography of thorax showed non-specific interstitial pneumonia. She had anemia, raised C - reactive protein, positive indirect Coomb’s test. Her Anti-Nuclear antibody, rheumatoid factor, anti-Sm, anti-Sm/RNP and anti-Ro antibodies were positive. Her anti-Citrullinated peptide antibody was negative. As she satisfied the diagnostic criteria for both lupus and rheumatoid arthritis, she was diagnosed as a case of rhupus syndrome. She was treated with pulse injectable methylprednisolone for 3 days and then shifted to oral prednisone, along with hydroxychloroquine, oral methotrexate, sildenafil, pirfenidone and torsemide-spironolactone