Thursday, 30 September 2021

Medical Journal: September 2021

Medical Journal: September 2021

Nephrology Specialists and Resident’s Perception towards Training Program at Sudan Medical Specialization Board (SMSB)

Abstract

Background: Optimum learning environments (LEs) are linked with positive training outcomes for residents. However, there is few data concerning how the residents perceive the learning environments in teaching hospitals. This study aims to analyze the residents’ perceptions of their learning environments.

Methods: This cross-sectional, hospital-based study was carried out between November 2020 and January 2021, using a Postgraduate Hospital Educational Environment Measurement (PHEEM) questionnaire. Statistical analysis was conducted using SPSS 20.

Results: The total number was 45 participants, 40 of them successfully responded. The total Cronbach`s alpha score was 0.93, which reflects good reliability. The full-scale score was 128 out of 160, which indicates a good learning environment. The autonomy score was 44, the teachers' score was 50, and social support was 34. Finally, the overall mean score for females was 43.3 compared to 39.4 for males, with a P-value of 0.55. Furthermore, no significant difference in residents’ perceptions of their learning environment according to their training was observed in this study.

Conclusion: Significant challenges in the LE were identified; more attention and effort should be given, especially to the poorly rated point in this study: the existence of an informative program, clear clinical protocols, and proper setting expectations. The lowest score was for catering, housing. A high social support score indicates a healthy workplace environment and job satisfaction.

Keywords— Nephrology specialists, residents perception, learning environment, training program.

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Friday, 17 September 2021

Medical Journal: August 2021

Medical Journal: August 2021

Evaluation of risk factors associated with nephropathy in type 2 diabetic patients in Rwanda

Abstract—

Background: Diabetic nephropathy is an emerging clinical and public problem and is related with poor outcomes such as heart failure, and end stage renal disease. In the Rwanda countryside there are no recent studies on renal complications.

Objective: To evaluate risk factors associated with nephropathy in Type 2 diabetic patients in Rwanda.

Methods: A case-control study was conducted from January to September 2019 in four hospitals of Republic of Rwanda. Diabetic patients were screened for nephropathy by measuring microalbuminuria. Those with microalbuminuria were the cases and those patients free of nephropathy were the controls. The study sample had 592 participants, 83 cases and 509 controls enrolled. Plasma glucose was measured by enzymatic colorimetric test. HbA1c test was performed using the unique procedure of Bio -Rad Variant II. Albuminuria was measured by quantitative method using spectrophotometer. Total plasma cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, Urea and Creatinine were assayed by colorimetric methods using commercial kits. A questionnaire was used to assess other risk factors such as alcohol consumption, smoking, level of physical activity, family history of T2DM, obesity, stress, and demographic status. The data was analyzed on SPSS version 20. Statistical analysis was performed by Chi square to show association in nominal and ordinal data. Multivariate logistic regression analysis to select independent variables was performed. Odds ratio was used as measure of association.

Results: In this study the prevalence of Diabetic nephropathy was 14%, (microalbuminuria was 12.5% and macroalbuminuria 1.5%). The major independent risk factors associated with diabetic nephropathy were male gender, long duration of type 2 diabetes (≥16 years), elevated HbA1c (> 7.5%) , poor adherence to diabetic medication, elevated creatinine (> 1.2 mg/dl), and lower level of education. Conclusion: Management of those modifiable risk factors of nephropathy could reduce its incidence in diabetic patients.

Keywords— Type 2 Diabetes Mellitus, Nephropathy, Risk Factors, Rwanda.

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Medical Journal: July 2021

Medical Journal: July 2021

Relaparotomy in Children in a Developing Country: A 10-Year Review

Abstract

Background: Complications arising from abdominal surgeries may necessitate a relaparotomy. The purpose of this study was to evaluate the indications, outcome and factors affecting mortality following pediatric relaparotomy in Enugu, Nigeria.

Methods: This was a retrospective study of children that had relaparotomy at the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. The parameters assessed included patients’ demographics and other factors that may affect mortality following relaparotomy using a multivariate analysis.

Results: A total of 683 laparotomies were performed during the study period, out of which 31(4.5%) patients had relaparotomy. The ages of the patients ranged from 2 weeks to 15 years, with a median of 10 years. Typhoid intestinal perforation was the most common initial pathology that necessitated the initial laparotomy and right hemicolectomy with ileotransverse anastomosis was the most common initial procedure performed. Anastomotic leak (61.3%) was the most common indication for relaparotomy and surgical site infection (29%) was the most common complication following relaparotomy. Mortality rate was 19.4% and statistical analysis (multivariate analysis) showed post-operative complication as the only factor that affected mortality (p value = 0.04).

Conclusion: Relaparotomy is inevitable in many unsuccessful primary laparotomies. The mortality rate in developing country like Nigeria is high and efforts should be made towards improving outcome.

Keywords: Abdominal, children, complications, developing country, relaparotomy, review.

What is already known about the topic: There is no publication on pediatric relaparotomy from West African. A literature search on pediatric relaparotomy in Africa showed only one paper from Ethiopia which recorded high mortality especially in neonates.

What does this article add: To the best of my knowledge, this is the first article from West Africa that brings up information on pediatric relaparotomy. This article adds information on the unique experience from West Africa.

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A Study on Effectiveness of Relaxation Technique on Anxiety among Hypertensive Clients in Selected Community in Jaipur

Abstract

Anxiety is a common experience of human beings that their minds and bodies are closely interlinked. Any disturbance in either of them is bound to affect the other. Mental worries lead to physiological problems and bodily discomfort does impact on the mind.

The study objectives are:

  1. To assess the level of anxiety among the hypertensive clients by using Beck anxiety scale.
  2. To find the effect of relaxation techniques on level of anxiety among hypertensive clients.
  3. To find an association between anxiety level and selected demographic variables.

The article assumes that

  1. Hypertensive client have anxiety.
  2. Relaxation technique (pranayama breathing) is effective techniques for reducing the level of anxiety on hypertensive clients.

Keywords— Community area; hypertensive clients, anxiety; Relaxation technique (pranayama breathing).

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Medical Journal: May 2021

Medical Journal: May 2021

Effect of Subcutaneous Administration of Teriparatide in Postmenopausal Osteoporosis

Abstract Postmenopausal osteoporosis is a serious health problem in Indian women as it increases chances of both vertebral and non-vertebral fractures. Currently standard treatment guidelines do not offer any effective prevention of osteoporosis. Teriparatide, in various international studies has been found as an effective treatment option for prevention of postmenopausal osteoporosis. However, there is very limited of data of Indian postmenopausal women. Therefore, present study is an attempt to observe the treatment effect of teriparatide for prevention of postmenopausal osteoporosis.

Objective: To observe the treatment effect of teriparatide in patients suffering from postmenopausal osteoporosis in terms of bone mineral density.

Methods: This randomized control study was done in 62 randomly selected patients with postmenopausal osteoporosis at SMS Hospital, Jaipur. After administering teriparatide (20 mcg daily), we measured lumbar spine, total hip and distal radius BMD at 6 and 12 months.

Results: At 6 months, lumbar spine BMD increased more in teriparatide group (0.74±1.43, P=0.007) than in control group (0±0.32, P=0.007) and at the end of 12 months also, lumbar spine BMD increased more in teriparatide group (0.8±0.43) than in control group (-0.03±0.41). Similarly, at 6 months, total hip BMD increased more in teriparatide group (0.36±0.45, P˂0.001) than in control group (-0.08±0.22, P˂0.001) and at the end of 12 months, total hip BMD increased more in teriparatide (0.59±0.45) than in control group (-0.1±0.36). ). At 6 months, distal radius BMD increased more in teriparatide group (0.44±0.74, P=0.004) compared to control group (0.00±0.37, P=0.004) and at 12 months, distal radius BMD increased more in teriparatide group (0.77±0.68) compared to control group (-0.04±0.43).

Conclusions: Teriparatide is an effective agent to treat postmenopausal osteoporosis and it is more effective at lumbar spine than at hip and radius. To conclude further treatment is needed as sequential therapy because on stopping treatment BMD again start receding over the period.

Keywords— Teriparatide, Postmenopausal women, Bone mineral density, Osteoporosis.

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Medical Journal: March 2021

Medical Journal: March 2021

A Review of Smoking on Cardiovascular Disease: Impact on Human Health

Abstract— Cardiovascular diseases (CVD) are the leading cause of global morbidity and mortality. They also inflict huge direct and indirect financial costs on the worldwide society. With the ready availability of affordable therapeutics globally, and the relatively slow development of newer therapeutics, lifestyle behaviors are gaining importance, both as preventive and therapeutic interventions. Smoking tobacco is consistently and strongly related with a higher risk of CVD incidence, adverse progression, and increased mortality. Smoking is deleteriously associated with most cardiovascular diseases. Smokers die of more CVDs than from any other cause. Cessation of smoking is therefore paramount in improving worldwide CVD health. This paper reviews the negative effects of smoking on cardiovascular diseases.

Keywords— Smoking, Cardiovascular Diseases, Lifestyles, Modifiable Risk Factors, Nicotine.

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HLA Ligand Binding in Cytokine Storm Stage with Convalescent Plasma Therapy: A Cytotoxic Activity Switching-off

Abstract— The potential of Convalescent Plasma Therapy (CPT) as the last effort for immunocompromised COVID-19 patients are not controversial anymore, but the mechanism which supports the anti-ligand-binding and memory cell should be broadly known. While p53 mutation associated CD4 has not been ready, memory cells could not know the lymphocyte induced up-regulation in cytokine storm stage, made lymphopenia. Keyword setting of lymphopenia mechanism-COVID-19, searching in Science Direct and other search engines, is used in this Systematic Review PRISMA design.

Immunocompromised patients including obese and old age is included, also Lymphocytopenia – ARDS, Diabetes Type 1. Cardiac arrest, cardiac arrhythmia, hypertension alone was excluded. References (15) that supported lymphocytopenia mechanism-COVID-19 are selected. About 15 million and 4,593 participants of COVID-19 patients with only 1½ Systematic Review due to the mechanism of lymphocytopenia and off reaction with CPT are recorded.

Lymphocytopenia cause by cytokine storm in week-2 COVID-19, while in low CD4 (Th) in this cytokine storm COVID-19, could be stronger and faster in week-1st in the second infection on person with diabetes. CPT serum, is the only way to switch-off cytotoxic activity, and increase the lymphocyte again.

Conclusions

CPT switch-off cytotoxic activity on Human Leucocyte Antigen (HLA) binding ligand in immunocompromised patients.

Keywords— Cytotoxic activity; HLA ligand binding; Lymphocytopenia; Lymphopenia; COVID-19; critical ARDS.

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Medical Journal: February 2021

Medical Journal: February 2021

Assessment of Undergraduate Medical Learners’ Perception of the Learning Environment using Modified DREEM Questionnaire: A Cross Sectional Study

Abstract

Background: The students’ perception of the learning environment is important for proper learning to take place. Students’ reflection in this regard is also crucial in the accreditation process. Sudan has witnessed huge expansion in higher education which resulted in many challenges facing the educational environment. This study aimed to assess the medical students’ perception of the learning environment at a Sudanese University, October 2019.

Methods and material: The study was descriptive cross-sectional. Medical students from 2nd to 5th class were chosen proportionately, using systematic random technique. Calculated sample size was 330. Data was collected using self-administered modified Dundee Ready Educational Environment Measure. 17 questions with total mean score of 68 involved assessment of five domains of the educational environment namely, Students’ perception of learning (SPL), Students̛ perception of teachers (SPT), Students’ academic self perception (SAS), Students’ perception of the atmosphere (SPA) and social self-perception (SSS). Data was analyzed using SPSS version 23.

Results: 315 students participated in the study with 95% response rate. Males were almost as twice as females. The total mean score was 37.8 out of 68 that means more positive than negative. 2 out of 3 SPL, 2 out of 5 SPA items, and one out of 3 SSS items were identified as problem areas. In total, 5 out of 17 items were identified as problematic. There was no statistically significant difference between males and females regarding the sub-groups (P >0.05). As regarding the association between students’ perception of the learning environment and academic achievement and class level; has shown significance only for the later with P values < 0.05 mainly between 5th and 3rd year.

Conclusion: Medical students’ perception of the learning environment at a Sudanese university was positive more than negative. Some items of the learning environment were in need of improvement. There was significant ascending difference between some of the classes in relation to perception of the learning environment.

Recommendations: Adjustment of the learning environment and continuous evaluation of students’ perception.

Keywords: Medical, students, perception, learning, environment.

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Epidemiological Trends of Lower Limb Amputation in Artificial Limb Centre

Abstract Main aim of our study was to compose an inclusive report on the “Epidemiological Trends of the lower limb amputation in two different population groups”. This is a retrospective study carried out at Artificial Limb Centre (ALC), Pune from 1st February 2012 to 31st January 2016. A total of 3402 patients who had undergone the prosthetic rehabilitation at the ALC, Pune were included in our study. All the patients after initial assessment were divided into two groups, 1. Defence Personnel’s & Dependents 2. Civilian patients.

The patients were evaluated with respect to age, sex, aetiology, site, level and prevalence of amputation among the sexes at different ages and surgical interventions performed and It was found that the physical trauma was still one off the leading cause of major Lower Limb Amputation in developing countries, but new emerging causes like “Metabolic and Vascular” were showing the continuously increasing trends. The reason for this change was rise in the diabetes & its associated complications. This study is therefore intended to provide an insight into epidemiological trends of major lower limb amputation in army personal, dependents and general population.

Keywords— Lower Limb Amputation, Trauma, Prosthesis, Defense Personnel, Artificial Limb Centre.

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Monday, 11 January 2021

Medical Journal: December 2020

Evaluation of the Inter-Premolar Width Changes in the Mandible using Three Different Commercial Arch Wires: A Prospective Clinical Study

Abstract

Objective: The aims of this study is to evaluate the inter-premolar width changes in the mandible using three different commercial orthodontic arch wires.

Subjects and methods: Thirty patients including both males and females have been allocated in this study. Three orthodontic wires including NiTi, copper NiTi, and Beta-Titanium wires had been used. A special observational technique including CBCT had been used to make an evaluation for the inter-premolar width before and after the aligning stage.

Results: The results showed a highly significant increase in post-treatment inter premolar width in CNA and NITI groups; compared to Cu NITI group; with highly significant statistical difference (p < 0.01 respectively).

Conclusion: The present study showed that there is a high significant increase in the inter-premolar width in the mandible, when comparing the wires in the groups (NiTi, CNA, and copper niti). Also, the gender of the patient does not seem to have an impact of the gender on post-treatment efficacy of each wire.

Keywords— Mandible, Commercial Arch Wires, NiTi, copper NiTi, Beta-Titanium wires.

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Performing Maxillofacial Surgeries during Covid19: Current Challenges and Possible Solutions

Abstract The world is witnessing an invasion from a new corona virus, which resulted in more than one million of deaths. Most of the sectors such industrial, economy, and tourism are facing a crisis, hence the workers in the field of medicine, considered to be the barrier to fight this invasion. This new virus seems to have two main transmission routes: direct and contact, which it will open a high chance of infection among professional health providers, especially, surgeons and dentists. Maxillofacial and dental surgeons, considered to be essential professional health experts that perform, multiple surgeries and dental procedures every day, consequently, these professions will exhibit a high risk of getting infected by Covid19, due to that, this review article aimed to discuss the possible ways that it may help in optimizing the level of infection control.

Keywords— Covid 19, corona virus, Maxillofacial Surgeries, health providers, dental surgeons.

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Ginkgo Biloba Polypeptide Preparation Key Technology Research

Abstract In this study, ginkgo powder was used as the research object, and neutral protease and flavor protease were selected to study the degree of hydrolysis of ginkgo protein. Using single factor test and orthogonal test, the results show that the addition amount of neutral protease is 1.6mg/ml, pH is 7.0, enzymolysis temperature is 44oC, and the reaction time is 4h, the best hydrolysis degree is 4.68%; flavor; The added amount of protease is 7.2mg/ml, pH is 6.5, enzymolysis temperature is 55oC, and the reaction time is 6h. The best hydrolysis degree is 24.95%; finally, the ginkgo polypeptide is obtained by separation and purification by 3kDa filter membrane. The yield rate was 8.73%, and the obtained filtrate was concentrated by a rotary evaporator to prepare a polypeptide concentrate.

Keywords— Ginkgo peptide; Enzyme hydrolysis; Membrane separation and purification.

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Assessment of the Inter-Molar Width Changes in the Mandible by using different Orthodontic Arch Wires: A Prospective Clinical Study

Abstract The demands for orthodontic treatment are in continuous increasing, hence producing an ideal treatment plan need to cover all stages of the treatment carefully, especially the retention and stabilization stage. As, any changing in the arch width through changing the inter-molar width will lead to impair the stabilization of the arch and will lead to relapse. Due to that, the present study performed to evaluate the inter-molar width of the mandible using three different commercial orthodontic wires. Thirty patients had been allocated in this study, using a cone beam computed tomography to create an assessment for the inter-molar width. It concluded that there is an increase in the inter-molar width between pre-treatment and after finishing of aligning stage, also there is a highly significant increase in post-aligning stage between the three groups.

Keywords— Inter-molar width changes, Orthodontic Arch Wires, retention stage, stabilization stage, NiTi wires.

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