Background: The haematological changes are common in cirrhosis of liver the cause of which is multifactorial. It should be correlated by determining the underlying pathology accordingly. Objective: The objective of the study was to evaluate the pattern of change in Haematological indices in Cirrhosis of liver. Methods: This is a cross sectional prospective study conducted on purposely selected (non-probability) hospitalized patients admitted to Medicine, Gastroenterology and hepatology departments of Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 100 cases of cirrhosis were selected as per inclusion and exclusion criteria. After selection clinical history, meticulous physical examination and rational investigations were done. Data were collected as per a structured standard questionnaire and checklist. Data analysis was done using statistical software package SPSS 22.0 and was compared with other studies. Results: Anaemia was found in 81 cases out of 100 patients. Anaemia was morphologically normocytic in 46% patients which is the highest number in this study group. It was microcytic in 40% patients and macrocytic in 14%. Regarding Leukocyte count it was normal in 70(70%) patients, Leukopenia in 12(12%) and Leukocytosis in 18(18%) patients. Regarding platelet count it was normal in 46(46%), thrombocytopenia in 51(51%) but thrombocytosis in 3(3%) of cases. The average platelet count in thrombocytopenic patients was 90 X 1091 ± 23 X 109/L. Lastly, pancytopenia was present in 14(14%) patients. Among them, 10 patients (71%) had splenomegaly. Iron Profile was done in all patients of microcytic anaemia and it revealed 68% of them were iron deficiency anaemia. Prothrombin time was done in all patients and it was prolonged in 54 (54%) and its average value was 16.13±.2.9 seconds. Conclusion: Haematological changes are common in cirrhosis of liver, the cause of which is multifactorial. Iron deficiency anaemia is the common type (68%).Prolong prothrombin time (54%) and thrombocytopenia (51%) are the common features.

Background: Palliative external beam radiotherapy (PRT) had been reported as an indispensable tool for an effective pain relief in cancer patients with metastatic bone pain. Although many scholars reported a link between pain perception and ethnic background of an individual, but its role in cancer patients with interplay of other tumour factors needs to be evaluated to ascertain the actual impact it may have on pain perception and responses to radiation analgesia. Methods: We retrospectively reviewed patient’s data of breast cancer with metastatic bone pain between 2015 and 2018. Patient’s demographic factors like age, sex, ethnic group, tumour histology, RBS grade and sites of metastasis were extracted and grouped accordingly. Other Radiotherapy doses used for palliation of pain were extracted. Visual analogue pain assessment scale (0-10) was used by doctors (majority from Hausa-Fulani ethnic origin) to asses’ pain at presentation and four weeks post-irradiation. SPSS version 23 was used for data analyses; univeriate and multivariate analyses were conducted to test for any significant associations between predictive factors and dependent variables. Results were presented in pie-charts, bar-charts and tables. Results: A total of 161 patients reviewed during the study period, 159 (99%) were females and 2(1%) were males with mean age of 45.2 years, the age groups of 20-29 yrs presented with highest pain score. Among the three major ethnic groups, Yoruba constituted 31.7% with mean pain score of 7.5 ±1.4, followed by Igbo (26.1%) with mean pain score of 7.1 ±1.4. The commonest histology were invasive ductal (IDC) and invasive lobular (ILC) carcinoma with each having 7 as the highest mean pain score. Patients with grade 2 and 3 were the commonest and presented with mean pain score of 6.9±1.4 and 6.7±1.6 respectively. Patients with spinal cord compression (5.6%) presented with highest mean pain score of 7.3±1.3, followed by metastasis to long bones with pain score of 7.0±1.5. Pain alone was the highest presenting symptom (92.5%) from bone metastasis and Conventional X-ray was the common imaging modality used in confirmation of metastatic sites (68.3%). Common palliative radiation doses used were 11-20Gy in 4-6# (60%). Overall mean pain score at presentation was 6.8 ± 1.5 and 0.6 ± 0.7 four weeks after irradiation. In univariate analysis (binary comporason) only ethnicity was highly significant (p-0.001) in pain perception pre-radiotherapy and the significance exist after controlling other influential factors using multivariate analysis (p< 0.001). In post-irradiation using univariate analysis, ethnicity and metastatic sites shows significant association with pain relief, after multivariate analysis when influential factors were controlled, it appeared only metastatic sites with p-value of 0.008. Conclusion: Ethnicity of three major tribes in Nigeria played a role in pain perception from bone metastasis at presentation, with Yoruba higher pain perception compared to Hausa-Fulani and Igbo. But ethnicity appeared insignificant in response to radiation analgesia. Similarly, tumour factors appeared in significant in pain perception and response to radiation analgesia. However, metastatic sites influence response to radiation analgesia, with good pain relief in patients with metastasis to ribs and long bones.

Background: Many advanced radiotherapy techniques had been employed in breast cancer teletherapy, purposely to significantly reduce dose to organs at risk (heart and lungs) with marginal or no compromise in planning target volume (PTV). Majority of used techniques yielded rewarding results in developed countries where facilities, manpower and skills are available. In Nigeria, significant number of post mastectomy breast cancer patients received chest wall irradiation using manual hand planning, therefore, the dose distributions to target volume and organs at risk (OAR) were uncertain. Sokoto centre being the first in the country to use treatment planning system (TPS) focused on identifying planning skills (normalization points) with good 95% dose coverage to PTV, and minimizing dose to OAR. Methods: Eighteen post mastectomy patients (ten rights and eight lefts chest walls) were simulated via computed tomography scan (CT-scan) in supine position with breast board and fudicial markers to demarcate tumour bed borders. Planning target volume (PTV chest walls) and OAR were contoured from the acquired CT images and bi-tangential portals were applied. The energy used from Elekta précised Linac was 6 MV, and dose of 50Gy in 25# was prescribed to each patient. The Upper 1/3rd normalization point (UNP), Lower 1/3rd (LNP) and Inter-field (INP) were sequentially applied as dose normalization points on each planning CT image, dose to PTV and OAR were evaluated using Clarkson and pencil beam calculation algorithms. Statistical analysis was conducted using SPSS Software to study dose distributions of the normalization points. Results: Patients simulated were between the ages of 29-56yrs with mean age of 42yrs. The mean percentage doses from normalization points on left chest walls ranged between 81.7-107.7% to PTV, 13.3-17.8% to the lung and 5.5-6.8% to the heart, the reported hot spots were between 110.7 to 141.5%. Similarly, the mean doses from normalization points on the right chest walls ranged between 81.5-108.8% for PTV, 17.8-23.5% to the lung and 2.7-3.7% to the heart, with hot spots of 108.8-137.9%. The statistical differences using independent-t- test for the normalization points on both left and right chest walls shows p-value < 5%. Conclusion: The three normalization points influenced dose distribution to PTV and OAR differently. The UNP and LNP showed a desired dosimetry with marginal compromise in 95% PTV coverage compared to INP.

Background: Numbness, tingling, discomfort, and/or weakness in the toes are symptoms of distal symmetrical polyneuropathy (DSP), which proceeds in a stocking-glove pattern proximally. There is still no particular therapy available. Objective: CPRF (caudal pulsed radiofrequency) is used to treat people who have sensory symptoms. Study Design: This is a prospective study at Alsdr teaching hospital in Iraq-Basra. Methods: CPRF, Boston Scientific G4™ RF Generator, Twenty-four subjects with DSP who were stimulated reported sensory complaints that did not respond to therapy. Under fluoroscopy at S2-3 level, inserted a caudal 21 gauge, 20-mm active tip RF cannula into the epidural space through the sacral hiatus. After the sensory and motor RF, give PRF at 5 Hz for 600 seconds at 45 V. Within the first week of the operation, the impact of activation was examined using a numeric rating scale, which was repeated every three months for the next three months. Patient satisfaction levels were assessed three months following treatment; patients who scored "7" (very good) or "6" (good) on the treatment satisfaction scale were rated fulfilled. Results: Neuropathic pain was effectively diminished after four visits (P< 0.001, test one-factor analysis). Furthermore, three months after receiving CPRF, more than half of the patients had an effective reaction (≥60 percent pain reduction) and were comfortable with the therapeutic outcomes. Limitations: The research included a small number of patients and was only for a brief time. Conclusion: CPRF is a safer, less expensive, and more effective way to treat symptoms.

Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. Due to the chronic and blinding nature of the disease, patients require prolonged clinical care and follow up. Patients’ satisfaction or dissatisfaction with care could be an important determinant to compliance and adherence to treatment to preserve visual fields and improve their quality of life. Purpose: To review existing literature on the level of patients’ satisfaction with glaucoma care services. Methodology: A systematic review of literature conducted online at the three search engines: PubMed, Scopus and Web of Science using key terms: (‘predictors’ OR ‘determinants’ OR ‘factors affecting’ OR ‘measurements’ OR ‘dimensions’ OR ‘aspects’ OR ‘attributes’) AND (‘patient satisfaction’ OR ‘patient experience’ OR ‘patient priorities’ OR ‘user satisfaction’ OR ‘customer satisfaction’ OR ‘consumer satisfaction’) AND (‘glaucoma’ OR ‘open angle glaucoma’ OR ‘angle closure glaucoma’ OR ‘POAG’ OR ‘PACG’). Quality assessment were conducted for each article and bias assessment by the principal investigator and another reviewer. Results: The primary search obtained 710 articles. Following review of titles and abstracts, a total of 27 publications were included in the review based on eligibility criteria. Majority of the studies had good reporting standard and external validity while there were poor scores for internal validity. Significant factors determining satisfaction and dissatisfaction were summarized. Conclusion: The patients’ satisfaction with glaucoma care varies and can be affected by several factors. Some of the factors can be modified to improve better patients’ experience and compliance to treatment.

Background: Dermatophytosis is a worldwide health-related problem, affecting 20-25% population globally. Once it was very easy to treat with either topical or systemic antifungal agents but now become a challenge for dermatologists because of increasing resistance against conventional antifungals fluconazole, itraconazole, and terbinafine with standard dosages and duration for the last few years in Bangladesh. Search for an effective new oral antifungal agent now become essential. Aim of the Study: To evaluate the efficacy and safety of the new antifungal agent voriconazole in the treatment of refractory and recurrent cases of dermatophytosis. Methods: The study was conducted in the outdoor patient department of Jahurul Islam Medical College Hospital, a rural-based tertiary care teaching hospital on 100 patients with extensive, recurrent, treatment failure cases of dermatophytosis. The clinical diagnosis was confirmed by KOH microscopic examination. Patients were given oral voriconazole at a dose of 200mg twice daily one hour after food for 4 weeks. The patients were followed up at week 2 to assess clinical response and any adverse effects from the prescribed drug. The final efficacy assessment was made at the end of week 4 with the combined evaluation of mycological results and the sum of clinical scores according to a 4-point physician assessment scale of 0-3 (0-absent, 1- mild, 2-moderate, 3- severe). Results: A total of 100 patients completed the clinical trial. Among them 52% were male and 48% were female. The 15-25 year’s age group was 34% and the 26-35 year’s age group was 24%. Majority of patients 56% had a duration between 6 months to <1 year. Of all patients, 100% had tinea corporis and tinea cruris was present in 85%. Involvement with outdoor work was present in 60% of cases. A Complete cure was seen in 82%, mycological cure was seen in 12%, and failure to treatment was seen in 6% cases. Adverse effects were seen in 40% of patients with visual disturbances in 27%, followed by headache and skin rash in 5% and 3% respectively Conclusion: Based on the result, it can be concluded that voriconazole is a highly effective and safe oral antifungal agent that can be used in the treatment of recurrent therapy-resistant cases of dermatophytosis.

Background: Hypertension is a non-communicable disease which is an important risk factor for cardiovascular diseases. The prevalence has been documented to be highest in Africa where 46% of the world’s population with hypertension reportedly resides. There is a global concern that hypertension in teenagers and young adults are on the increase and cases are not detected because of inadequate screening in this age group. Objective: To determine the prevalence of hypertension among undergraduates in Rivers State. Materials and Methods: This was a cross-sectional study conducted in Rivers State. The subjects were recruited from University of Port Harcourt, Rivers State University and Ignatius Ajuru University which are the three major tertiary institutions in Rivers State and their ages ranged between 16 and 35 years. Data collected were analyzed using Statistical Package for Social Sciences. Results: A total of 1096 respondents were recruited for the study, there were 570 (52%) males and 526 (48%) females. Sixteen (1.5%) of them were married while 1080 (98.5%) were single. The prevalence of hypertension among the respondents was 21%. Adding salt to meal before eating and noodles consumption were significantly associated with hypertension. Other risk factors which included smoking, alcohol consumption, and physical inactivity, family history of hypertension and/or CVD and use of social drugs were not significantly associated with increased prevalence of hypertension. Conclusion: The prevalence of hypertension was high in this study there was a significant association between hypertension and risk factors such as salt intake and noodles consumption. Health practitioners should enlighten the public on the presence of hypertension in young people. There is also need to create awareness of hypertension even in young adults and promote early lifestyle changes.

Introduction: The intensity of the work and the diversity of the acts imposed, in the operating room, provided organization and complementarity of the different actors. The dysfunctions observed are the cause of delays, reports or additions to the operating program our study consisted in evaluating, within the our department of operating theaters, the deadlines of patients who were to be performed under general anesthesia in scheduled surgery, from their arrival in the operating room until the incision, and to identify the causes and possible consequences. Materials and Methods: This is a prospective observational study carried out at HMIMV, between March 1, 2018 and April 1, 2018, Results: The median waiting time in the reception room was 42 minutes, and 65% of patients waited between 25 and 62 minutes the main causes of delay in the operating room were at 38% of cases, the unavailability of the anesthesiologist. In more than 22% of cases the non-availability of State Certified Nurse Anesthesiologist in 19% of cases the unavailability of the surgeon. We then find almost 5% of expectations due to equipment defective or missing. Some causes were not specified for nearly 3% and about 3% of cases the non-availability of the State-certified operating room nurse. It is in the sectors of orthopedics and digestive endoscopy that predominates expectation of surgeons and to a lesser extent that of anesthesiologist-resuscitator. However the unavailability of the anesthesiologist-resuscitator was predominant in visceral surgery and in Gynecology. Conclusion: Optimizing an operating theater means making it possible to operate on more patients, in different better safety conditions and with a level of quality and comfort for the patient satisfied.