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Experience of medical students in pediatric emergency simulation at King Abdulaziz University Hospital-Jeddah
Get PDFObjectives: To assess the learning experience of undergraduate medical students during running a pediatric emergency scenario.
Methods: This cross-sectional study was conducted at the Clinical Skills & Simulation Center in King Abdulaziz University in Jeddah, Saudi Arabia in the academic year 2015-2016. The sample was comprised of all 5th year medical students (n= 179; 80 males and 99 females) studying at King Abdulaziz University in Jeddah, Saudi Arabia who are exposed to Simulation-Based Learning (SBL). To gain a better understanding of students’ satisfaction about simulation-based learning, a self-developed questionnaire on a Likert scale that indicated degrees of satisfaction was used to assess most of the dimensions in the questionnaire.
Results: All students responded positively, reporting that the simulation session provided realistic scenarios with good-quality briefing, debriefing, and an overall excellent learning experience with mean score (4.35±0.92).
Conclusion: Although there were few challenges, 57% of the students strongly agreed that simulation must be part of the undergraduate curriculum (question 9 table 2)
THE STUDY OF CLINICAL PROFILE IN MIGRAINE PATIENT
Get PDFBackground: Migraine contributes to 16% to the headache patients and it is the 2nd most common cause of headache affecting 15% of women and 6% of men worldwide.
Aims and objectives: Purpose of this study was to review detail demographic and clinical profile of migraineurs along with the study of practice patterns of acute treatment and prophylaxis in patients attending OPD of a tertiary care hospital of central India.
Material and methods: All the patients with migraine attending OPD in Department of Medicine formed our study population. The Study protocol and informed consent form (ICF) was approved by the Scientific Review Committee. We had included 100 consecutive patients of migraine during the study period (February 2015 to October 2015) after voluntary written informed consent for participation in the study. Data was presented in the form of tables, a bar diagram, and a pie chart.
Results: Maximum number of migraine patients were in the age group 21-30 years (46%), lower incidence of migraine was seen in higher age group patients. The overall mean age of onset of migraine was 29.5 years, with a lower mean age in females. Migraine was more commonly seen in females (69%) in comparison to males (31%). Majority of the patients in our study presented with migraine without aura (89%). Unilateral headache was seen in 69% patients and 31% of patients had a bilateral headache. 72% of patients had severe pain, while 28% of patients had moderate pain. Traveling (42%), tension (32%) and hunger (24%) were the most common precipitants. 97% were taking NSAIDs for an acute attack of migraine and only 3% were taking Triptans. 21% of patients had positive family history of migraine. Prevalence of migraine in migraineur’s parents to be 52.9%,
Conclusion: Females are most commonly affected by migraine. Travelling, tension and hunger being the most common precipitating factors. NSAIDs are most commonly prescribed for migraine. We recommend that further large clinical as well as epidemiological studies must be conducted to confirm and further extrapolate our findings in the general population
CLINICAL UTILITY OF CAT SCORE IN PATIENTS WITH COPD EXACERBATION AND STABLE DISEASE AND ITS CORRELATION WITH PULMONARY FUNCTION TESTS: AN OBSERVATIONAL PROSPECTIVE STUDY
Get PDFBackground: Burden of COPD is on rising and is a common cause of hospitalization and mortality. Presently Pulmonary Function Tests (PFT) is the common diagnostic tool as well as tool for assessing severity of COPD. However, PFT are not routinely available at Primary Health Centre. Present research aims to study clinical utility of CAT score for assessing COPD severity so that it can be used where PFT is unavailable.
Materials & Methods: Aim of this study was to assess the correlation between CAT score and PFT parameters in stable COPD and its exacerbation. 50 patients from both form of the disease were included in the study. CAT score was noted & PFT was performed for stable COPD patients during their routine OPD visit and at day1 & day5 for those requiring hospitalization for COPD exacerbation.
Observations: We found significant difference between each study group (Stable COPD patients, Day1 of COPD exacerbation and Day5 of COPD exacerbation) in all three parameters i.e. CAT score, FEV1 (%pred) and FVC (%pred) (p<0.05). CAT score also correlates with the change in FEV1 (%pred) and FVC (%pred) during a COPD exacerbation. Also, there was negative correlation between FEV1 (%pred) and FVC (%pred) with CAT score in stable COPD patients.
Conclusion: CAT scores correlates with PFT parameters in stable COPD as well as acute exacerbation of COPD.
Outcome: CAT score can be utilized to assess the severity of COPD especially in resource limited setups where there is no facility for Pulmonary Function Testing and also it is cost effective
CLINICAL CHARACTERISTICS OF PATIENTS WITH DIABETIC FOOT ULCERS AND PATHOGENS ISOLATED FROM WOUND CULTURES
Get PDFObjective: Diabetic foot ulcers (DFUs) are a major cause of morbidity and mortality and develop in the presence of peripheral vascular ischemia and neuropathy. Poorly controlled diabetes is an additional risk factor. DFUs are often polymicrobial. The types of isolated microorganisms (MOs) show regional variations: Gram-negative MOs are more common in temperate climate regions such as Africa and Asia and Gram-positive pathogens are more prevalent in western regions. We conducted a retrospective review of microorganisms isolated from 24 patients with DFUs.
Methodology: Twenty-four patients (17 males, 7 females) with a mean (±SD) age of 64.5±8.7 years were included. There was no significant difference in age between males and females. All patients had type 2 Diabetes Mellitus (DM) with a mean disease duration of 15±7 years.
Results: Considering the type of ulceration, 5 patients had superficial infections such as cellulitis, 16 patients had ulcers with the involvement of subcutaneous tissues and 3 patients had gangrenous ulcers. The diameter of ulcer was less than 2 cm in 9 patients, 2 to 4 cm in 11 patients and greater than 4 cm in 4 patients. The growth of the following MOs as single agents were detected in the wound cultures: Staphylococcus aureus in 5 patients, Escherichi acoli in 4, Morganella morganii in 4, Pseudomonas aeruginosa in 3, Klebsiella pneumoniae in 1, Serratia marcescens in 1, Proteus mirabilis in 1, Enterococcus faecalis in 1, and Stenotrophomonas maltophilia in 1 patient. Three patients showed concomitant growth of 2 pathogens (Enterobacter aerogenes+Escherichia coli; Enterobacter aerogenes+Staphylococcus aureus; Pseudomonas aeruginosa+Staphylococcus aureus). Peripheral artery disease (PAD) was present in 10 patients. Six microorganismsElbuken G. et al., Med. Res. Chronicles., 6(2), 68-76 2019 The corresponding author* patients were being treated with antibiotics (ABs) and local wound care including regular dressing changes and 18 patients required surgical treatment (debridement and local flap in 14 and amputation in 4). Of 4 amputated patients, 2 had a history of toe amputation. The average length of hospitalization was 12.9 ±7.1 days, mean HbA1c level was 8.1±1.6%, and mean duration of AB treatment was 11.7±3.2 days.
Discussion and Conclusion: Despite earlier diagnosis of DM and current availability of more effective therapeutic options, DFUs are still the leading cause of amputation. Along with blood glucose regulation, careful follow-up of diabetic complications and timely implementation of preventive actions would substantially reduce hospitalization and loss of productivity
COMPARISON OF QTc AND QT DISPRESION IN PREDICTION OF CARDIOVASCULAR MORTALITY AND MORBIDITY AMONG THE PATIENTS WITH CHRONIC RENAL FAILURE
Get PDFIntroduction: QT interval dispersion (QT-d), measured as the difference between the maximum and minimum QT interval on a standard 12 lead electrocardiograph (ECG), is a normal phenomenon. Corrected QT interval (a rate related QT interval), QTc can be calculated on QT/√R-R and normally is ≤0.44 second. Corrected QT interval dispersion can predict adverse cardiovascular outcome however QTd is a measure of regional heterogeneity in myocardial repolarization.
Aim: The objective of the present study is to assess the effects of cardiovascular morbidity and mortality by comparing the predictive values of QTc and QTd in the patients with chronic renal failure. Along with this the study also evaluates the relationship of QTc and QTd with serum sodium and potassium.
Materials and methods: Patients of chronic renal failure were included in the study. Patients of both gender and age of above 15 years with CRF on hemodialysis were selected for the study. Routine biochemistry levels, including sodium, potassium, and ionized calcium was measured pre and post hemodialysis at the time of ECG. Patients over 15 years of age with serum creatinine level >1.5 mg/dl and blood urea >40 mg/dl were included in the study.
Results: A total of 40 patients from both genders (24 males and 16 Females) were studied. 7 patients (20.5%) of CRF died of various causes in the 1-year follow-up period. 6 (15%) patients died due to cardiovascular causes whereas 1 (2.5%), the patient died due to blood transfusion reaction. There is a statistically significant difference found between the mean values of QTd and QTc between predialysis and post dialysis measurement. The t value shows the QTd value is more significant in case of prediction of Hypertension, CHF, IHD and Arrhythmias in CRF patients on haemodialysis. The QTc interval calculation may represent a simple method of monitoring patients with high risk of sudden death
THE EFFECT OF VACCINATION AND CHILDHOOD MORBIDITY ON NUTRITIONAL STATUS OF PRESCHOOL CHILDREN IN THE NIGER DELTA REGION OF NIGERIA
Get PDFBackground: Malnutrition is a major contributor to childhood morbidity and mortality especially in developing countries. Lack of vaccination and recurrent childhood diseases are important contributors to the burden of malnutrition in these countries.
Methods: A cross sectional study was carried out in Okrika town, the headquarters of Okrika Local Government Area in Rivers State, Nigeria. A multistage random sampling method was used to recruit 410 under-fives. A structured questionnaire was used to obtain demographic and vaccination data, history of diarrhoea, fever and respiratory tract infection.
Results: Of 410 under-fives studied, 217 (52.9%) were males. Forty three (10.5%) were underweight, 219 (53.4%) fully vaccinated, 42 (10.2%) unvaccinated while 56 (13.6%) and 68 (16.5%) had fever and symptoms of respiratory tract infection (RTI) respectively. The prevalence of underweight malnutrition was significantly higher among unvaccinated children (26.2%), among those with RTI (23.5%), fever (21.4%) and diarrhoea (30.8%). The risk of underweight malnutrition was 3.6 times and 2.8 times higher in those with RTI and fever respectively.
Conclusion: Complete vaccination, prevention and prompt treatment of childhood illnesses among under-fives will improve their nutritional status
ANTI-GLOMERULAR BASEMENT MEMBRANE ANTIBODY DISEASE AND ITS OUTCOME
Get PDFAnti-glomerular basement membrane (anti-GBM) disease is an aggressive autoimmune disease which affects glomerular capillaries, characterized by glomerular fibrinoid necrosis and crescent formation with or without pulmonary hemorrhage. Patients presenting with dialysis-dependent renal failure have poor renal outcomes. There is limited data regarding the clinical presentation and outcomes of antiGBM disease from India.
Aim: To study the incidence, clinical, biochemical and pathological characteristics and outcome of patients with anti-glomerular basement membrane (anti-GBM) antibody disease.
Methods and Material: This is a retrospective study conducted by screening renal biopsy reports of patients presented with rapidly progressing glomerulonephritis (RPGN) over a period of 45 months(JAN 2015-OCT 2018) Those patients who had histopathological features suggestive of ANTI GBM disease or those who had positive ANTI-GBM antibody titers were further analyzed. Their records were reviewed for the duration of symptoms before presentation, clinical features, and biochemical, pathology and serology reports. Follow up details were noted.
Results: A total of 97 patients presented with RPGN during the period of 45 months (Jan 2015 to Oct 2018). Anti GBM disease (10/97) constituted 10.30% of rapidly progressive glomerular disease. Males and females were equally affected (M: F 5:5), males mean age; 43.6+ 6.9 yrs and females mean age 28.8+ 10.1 yrs. The presenting symptoms were pedal edema (80%), oliguria (60%), hematuria (40%) and hemoptysis (20%). Kidney biopsy was done after a mean period of 10.7+ 7.2 days after first presentation. Mean sr. creatinine was 7.7+ 3.3 mg/dl, Only 2 patients had a creatinine of <5 mg /dl. Eight patients screened for circulating anti-GBM antibodies were positive and one patient positive for p-ANCA. Mean crescents per biopsy specimen were 71 %, 3 had 100% crescents (30%).
Conclusions: Anti GBM disease constituted 10.30% of rapidly progressive GN. Males and younger females were predominantly affected .All patients had >50% crescents and severe renal failure at presentation. Despite adequate immunosuppressive therapy all of them developed ESRD, due to delayed presentation
Role of nanotechnology in oral cancer diagnosis and therapeutics
Get PDFOral cancer is a multifactorial disease, but tobacco is considered as the most predominant attribute for its advancement. It can be preventable by the interruption of risk factors. Its early detection can minimize its detrimental effects and can improve the quality of life as well as morbidity and mortality of the patients. Nanotechnology is a very different field that has transformed the industry and is setting new directions in the treatment of oral cancer. Nanotechnology conversed methods can be used in cancer treatment. They can aid to have a better diagnosis with limited injurious substance. Nanotechnology is a very different field that has revolutionized the industry and is setting current directions in the management of oral cancer. The application of Nanotechnology significantly benefits clinical practice in diagnosis, treatment, and management of cancer. Hence, Nanotechnology can be also accustomed to molecular imaging accompanied by tomography and photoacoustic imaging of tumors and management of cancer as photothermal and radiotherapy. Nanotechnology a succeeding generation techniques have numerous advantages to treat patients of cancer from diagnosis to treatment
Synchronous primary tumors of the kidney and the ovaries: Case report
Get PDFSynchronous primary tumors are a rare finding and that to dual malignancy involving the kidney and ovary is extremely rare. Diagnosing double malignancy is always a clinical challenge. Only a few cases are reported in the literature with synchronous primary malignancies of the kidney and the ovaries. We present a case of a 60- year-old lady, presenting with pain abdomen. Her reports showed a right kidney mass and ovarian mass which suggested it to be a metastatic case but after surgery immunohistochemistry (IHC) from the ovarian mass was immunoreactive to CK7, WT1, ER and nonimmunoreactive to CK20, RCC, CD10. Cells from the right kidney tumor were immunoreactive to PAX8 on the basis of IHC patient was diagnosed with bilateral ovarian adenocarcinoma and a simultaneous clear cell carcinoma of the right kidney. Right renal cell carcinoma was pT1bN0 whereas bilateral ovarian carcinoma was stage pT1cN0. As per current treatment guidelines, patient has been started on adjuvant chemotherapy
Male hypogonadism in diabetes
Get PDFHypogonadism is defined as “inadequate gonadal function, as manifested by deficiencies in gametogenesis and/or the secretion of gonadal hormonesâ€1. The gonads (ovaries or testes) produce hormones (testosterone, estradiol, antimullerian hormone, progesterone, inhibin B, activin) and gametes (eggs or sperm