International Journal of Integrated Health Sciences
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Crowned Dens Syndrome: A Rare Cause of Sudden Onset Neck Pain
Get PDFObjective: To report a case of Crowned Dens Syndrome (CDS), which is a rare disorder caused by crystal deposition by calcium pyrophosphate dihydrate in the peridontoid soft tissues surrounding the C1 and C2 vertebrae that presents in elderly with sudden onset neck pain, neck stiffness, fever, and elevated inflammatory markers, with periodontal calcification in a halo or crown configuration on radiography considered diagnostic.Methods: A 64-year-old diabetic and hypertensive female patient presented with a 6-day history of sudden onset posterior neck pain and stiffness. Movements of the cervical spine were equally limited in all directions, causing marked aggravation of pain. There was no focal neurologic loss. Her inflammatory markers were markedly raised.Results: Based on radiography, she was diagnosed with Crowned Dens syndrome and started on oral prednisolone, paracetamol, and tizanidine along with topical diclofenac. Oral NSAIDs were contraindicated due to her renal insufficiency.Conclusion: Crowned Dens Syndrome (CDS) is a rare cause of neck pain. Clinicians should consider this syndrome in their differential diagnosis. Timely diagnosis and treatment of CDS will lead to avoidance of unnecessary investigations and medications in such patients, along with a reduction in the length of stay
Clinical Profile of Mucormycosis during the Second Wave of COVID-19 in a Tertiary Care Center in India
Get PDFObjective: To study the clinical profile and treatment outcome of mucormycosis associated with the second wave of COVID-19 pandemic.Methods: An observational study was conducted in a tertiary care center over a period of 12 months, including a 6-month post treatment follow up. Study included all COVID positive patients with a clinical and radiological evidence of rhino-orbito-cerebral mucormycosis during the second wave of COVID-19. All patients underwent further diagnostic workup and confirmed cases underwent surgical debridement and Amphotericin B was started.Results: A total of 59 patients presented with mucormycosis with the mean age being 52.7 years and unilateral facial and orbital edema as the most common symptoms (28.8%). All were diabetic with HbA1c >7 in 54.2%. The mean duration of presentation was 20.7±7.9 days from the onset of COVID-19 infection. Unilateral involvement of the paranasal sinuses was the most common finding in MRI. Early administration of Amphotericin B with prompt surgical debridement was performed in all cases. Orbital exenteration was conducted in nine patients for better fungal load clearance. Patients showed a good response to surgical debridement and prompt medical treatment, with a mortality rate of 27%.Conclusion: COVID-19 associated mucormycosis is difficult to treat and often presents in late stage. Uncontrolled diabetes, immunocompromised state, and steroid-induced immunosuppression were important risk factors. A close surveillance for early identification and initiation of treatment is mandatory. Repeated surgical debridement to clear the dead tissue is effective to control fungal load.
Fetal Exposure to Risky Drugs: Analysis of Antenatal Clinic Prescriptions in a Nigerian Tertiary Care Hospital
Get PDFObjective: To assess fetal outcomes after in-utero exposure to unsafe drugs.Methods: This was a retrospective cohort study using data from medical records of pregnant women who received antenatal care over a two-year period (2019/2020). Inclusion was based on identification of prescription of potentially risky medications during pregnancy. Medication records, as well as delivery data, were extracted for analysis. The Australian drug evaluation committee classification system of risky medications was used for analysis.Results: Results showed that 44 – 65% of medicines prescribed in pregnancy carry significant risks to fetal wellbeing. Fetal outcomes showed high levels of low birth weight, still birth, and early neonatal death. The common medicines prescribed irrationally in pregnancy were, among others, antibiotics, ACEIs, NSAIDs, Biguanides, and opiates, all of which are associated with adverse fetal outcomes.Conclusion: There is a high level of fetal exposure to risky medications and adverse delivery outcomes. There is a need to improve prescription through prescriber training and awareness raising on existing guidelines on good prescribing practice for pregnant women
Association between Comorbidities and COVID-19 Mortality: a Cross-Sectional Study in a Community Health Center in Indonesia
Get PDFObjective: To analyze the risk factors for mortality and comorbidity of COVID-19 patients in a public health center work area in Indonesia.Methods: This was a cross-sectional observational analytic quantitative study using secondary data of 820 confirmed COVID-19 cases in Brebes Public Health Center work area during the period of June 2020–December 2021. Univariate and bivariate analyses were used to analyze the obtained data statistically with a p-value of 0.05), and diabetes (p=0.000, OR=2.87, 95% CI 19 1.24-0280) were significantly associated with mortality.Conclusion: Comorbidity status, diabetes, and the place quarantine are risk factors for mortality among COVID-19 confirmed cases, especially in Brebes Public Health Center work area. Thus, it is important to increase knowledge about COVID-19 prevention and risks to prevent transmission among those with higher risks for mortality. Further studies on factors related to sustainable supports for COVID-19 patients are also necessary
Removal Technique of Penetrating Nail in Head: A Case Report
Get PDFObjective: To present a unique case involving a 44-year-old man who sustained a penetrating head injury after nailing his head with a hammer. Despite the severity of his injury, the patient underwent successful surgical treatment and experienced a good recovery.Methods: Clinical and imagery review was performed on a cranial puncture trauma caused by a metal nail, which penetrated the cranium, dura mater, right parietal cerebral parenchyma, and right ventricle. The nail was lodging next to midline without damaging the superior sagittal sinus. The patient underwent craniotomy nail removal and debridement with normal saline and metronidazole antibiotics.Results: Craniotomy, careful nail extraction, wound debridement, and duraplasty remain the treatment standard for penetrating nail injury in the head. Patient in this case study did not exhibit any signs of neurologic deficit or infection.Conclusion: Proper diagnosis and treatment are required in patients with penetrating brain trauma, with head x-rays and CT scans help in evaluating vascular depth and damage. Craniotomy and debridement are the main treatments for this type of trauma
Conservative Management of Pott's Spine and Its Outcome: An Institute-Based Observational Study
Get PDFObjective: To analyze the functional outcome of cases with Pott’s disease treated solely by antitubercular drugs.Methods: This observational study was conducted at the Department of Orthopedics of a tertiary care medical college. Sixty patients with Pott’s disease were included in this study based on predefined inclusion and exclusion criteria. All patients received antitubercular drugs for nine months. The Modified McCormick Scale (MSS) was used to assess the outcome of patients.Results: Out of 60 patients, 37 (61.67%) were females, and 23 (38.33%) were males, with an M: F ratio of 1:0.62. Most patients had some or the other risk factors and belonged to low socioeconomic status. The most common presenting complaint was low back pain, and the thoracolumbar spine was most commonly involved. There was a significant improvement in the patient’s functional status as assessed by the MSS score.Conclusion: If diagnosed early, patients with Pott’s disease can be treated solely by antitubercular treatment with excellent outcomes
Oxidative Stress in Seminal Plasma Negatively Influences Sperm Quality in Infertile Males
Get PDFObjective: To investigate the association between malondialdehyde concentration in the seminal plasma of infertile men and sperm quality.Methods: This case-control study included 60 male participants ranging from 25-40 years old with half of them were fertile and the other half were infertile. Semen analysis was performed as per the WHO standards, and spectrophotometric measurement of seminal plasma malondialdehyde level was done.Results: Results showed that infertile men had significantly a higher mean level of malondialdehyde in their seminal plasma than fertile men (p<0.001), which was inversely associated with sperm count and motility. Also, malondialdehyde was positively associated with abnormal sperm morphology.Conclusions: Elevated malondialdehyde levels in seminal plasma are associated with poor sperm quality. Malondialdehyde testing can, therefore, be used to diagnose and predict the outcome of male infertility. Antioxidants should also be administered to men with infertility to help counteract the effects of oxidative stress
Diabetes Retinopathy Prevalence and Risk Factors among Diabetic Patients Seen at Highland Eye Clinic Mutare Zimbabwe: A Retrospective Study
Get PDFObjective: To determine the prevalence of diabetic retinopathy and its association with hypertension, age, gender, and fasting blood glucose level.Methods: This retrospective study assessed the prevalence of diabetic retinopathy with its associated risk factors on 135 diabetic patients, aged 18 years and above, visiting the Highland Eye Clinic Mutare, Zimbabwe. Data were collected on the age, sex, and type of retinopathy. Based on the identified retinopathy, subjects were divided into no retinopathy, non-proliferative diabetic renopathy, and proliferative diabetic retinopathy groups. Analysis were then performed using multivariate and univariate regression analyses to test the association between the presence of retinopathy and several risk factors, and results were presented in percentages, with P< 0.05 considered to show statistical significance.Results: The average age of the subjects this study was 60.8 ± 14 with female subjects constituted more than half of the total number of subjects (58.5%). Forty four percent were overweight (BMI 25-30), 34.8 % were obese, and the overall prevalence of diabetic retinopathy was 31.1% (non-proliferative diabetic renopathy, 20%; proliferative renopathy, 11.1%). The proportion of subjects with retinopathy increased with duration of DM, being 23.3% in those with a DM duration of less than 10 years and 46.6% in those with a DM duration of more than 10 years. Age and hypertension were significantly associated with the presence of diabetic retinopathy (P< 0.05) in univariate analysis, but no association was identified between retinopathy and fasting blood glucose (chi-square test, P =0.0965)Conclusion: The prevalence of diabetic retinopathy (DR) is high (31.1%), Non-proliferative DR is more common than the proliferative (DR). There is a strong association between diabetic retinopathy, hypertension, and age
Under-Two Children Hunger Levels in Indonesia
Get PDFObjective: To analyze the hunger level of toddlers under 2 years old using the Under-two Children Hunger Index (CHI). Methods: This study used secondary data from the Indonesian Basic Health Survey 2018. This study focused on the development of measurement for under-two children hunger index (CHI) using six indicators of the prevalence of chronic energy deficiency in pregnant women; the prevalence of risk height of pregnant women; the prevalence of under-two children who never being breastfeed; the prevalence of malnutrition for under-two children; the prevalence of wasting for under-two children; and the prevalence of stunting for under-two children. These six indicators were weighted differently and were calculated using the Principal Component Analysis (PCA) method.Results: The calculation of CHI using loading factors as weighted indicators has a higher precision with the percentage of 94.12 percent. With a 2018 CHI score of 46.40, Indonesia is at a serious CHI level. From the 34 provinces in Indonesia, 47.06% of provinces are at an extremely alarming level, 8.82% are at an alarming level, 17.65% are at a serious level, 17.65% are at a moderate level, and 8.82% are at a low level. Efforts can be performed by the government to increase the CHI based on the 6 indicators mentioned above.Conclusion: Based on this analysis, 25 provinces need attention in terms of the CHI level with six, three, and sixteen provinces suffered from a serious, alarming, and extremely alarming levels of CHI, respectively. Nevertheless, CHI is dynamic and should be updated annually to assess the province’s achievement in eradicating hunger. This time-series data is very important to evaluate government programs and programs to accelerate the eradication of under-two children's hunger should focus on the six indicators in this study.
Depression, Anxiety, and Stress due to Changes in Employment Status during COVID-19 Pandemic: A Study in Badung Districts, Bali, Indonesia
Get PDFObjective: To determine the relationship between depression, anxiety, and stress with the employment status of people in Bali during Covid-19 pandemic.Methods: This study was a cross-sectional analytical study conducted in Bali, Indonesia, in 2021. The instrument used was DASS-21 questionnaire, which was distributed to a total sample size of 96 people. The relationship between variables were analyzed with a p-value of <0.05 as the cut-off for a significant relationship.Results: Depression symptoms had a significant relationship with gender (p=0.024) while anxiety symptoms had a significant association with the employment status during the pandemic (p=0.027). Similarly, stress symptoms also had a significant relationship with gender (p=0.007) and employment status during COVID-19 pandemic (p=0.007).Conclusion: There is a relationship between depression, anxiety, and stress due to changes in employment status during the COVID-19 pandemic in Badung Districts, Bali