Saudi Journal of Medicine (SJM) | Volume-4-Issue-05
Volume-4-Issue-05
Review Article
May 11, 2019
Hypertelorism
Arun Ramaiah, Nithin Sylesh R, Rahul Vinay Chandra Tiwari, Muhaseena M, Teertha S Shetty, Dani Mihir Tusharbhai, Heena Tiwari
Page Numbers : 347-350
DOI : 10.36348/sjm.2019.v04i05.001
The term orbital hypertelorism denotes “widely apart orbits.” This may also be associated with the abnormal orientation of the orbits in terms of the vertical position (dystopia). This deformity may be seen unilaterally or bilaterally. They may present as symmetric or asymmetric and can manifest in a variety of craniofacial conditions. The treatment is primarily carried out for aesthetic reasons. This paper emphasizes on the current understanding of this condition
Original Research Article
May 13, 2019
Prevention of Health Care Associated Infection: Time to Prime Students on Hand Hygiene!
Background: In today’s era of preventive medicine, infection control practices hold the centre stage for prevention of Health care associated infection. Adequate knowledge and compliance of hand hygiene is undoubtedly the most essential component which needs to be instilled in all health care personals including medical undergraduate students. Objective: The present study aimed at assessing the knowledge and awareness of hand hygiene in students of a Medical college. Methodology: A cross sectional questionnaire based study was conducted in a medical college teaching hospital and included students from I MBBS, II MBBS, III MBBS part I and II and also students undergoing internship in the hospital. Results and discussion: A total of 383 participated in the study and assessment of the students regarding their awareness showed that over all the awareness regarding the relevance of hand hygiene ranged between 39.2% and 89.2%. The knowledge aspect ranged from 36.6% to 64%. The study showed that overall the students were aware, but lacked knowledge in few important aspects of the laid down protocols of hand hygiene (80.5%vs 56.7%). Comparison of different batches showed a significant difference (p<0.05) in responses of various batches. The study results are in concordance with other studies in literature, where too a gap in knowledge has been realized. Conclusion: Need for introduction of hand hygiene practices in the early years of Medical graduate curriculum with adequate emphasis on all keys areas and thereafter a continued plan for educational and training program
Review Article
May 15, 2019
Medical Management of Oral Submucous Fibrosis in Its Initial Stages
Swetha Reddy Annam, Ganapati Anil Kumar, V K Sasank Kuntamukkula, Rahul Vinay Chandra Tiwari, Umesh Kaswan, Heena Tiwari
Page Numbers : 357-360
DOI : 10.36348/sjm.2019.v04i05.003
Oral submucous fibrosis (OSF) is an insidious, chronic, progressive, debilitating disease. It has amalignant potential resulting from progressive juxtaepithelial fibrosis of the oral soft tissues, resulting in increasing loss of tissue mobility, marked rigidity and an eventual inability to open the mouth. The hallmark of the disease being sub mucosal fibrosis that affects most parts of the oral cavity, pharynx and upper third of the oesophagus and its clinical presentation depends on the stage of the disease at detection. As the disease has a spectrum of presentation, the management differs with the various stages of the disease. This articles presents a review of the existing literature pertaining to the effectiveness of medical management of Oral submucous fibrosis in its initial stages
Original Research Article
May 22, 2019
Incidence and Trends of Ischemic Heart Disease and Coronary Revascularization Procedures in Gaza: A Descriptive Retrospective Study
Mohammed Habib, Mohammed Adwan, Mohammed Radi, Mohanad Qwaider, Mahmoud Altayyan
Page Numbers : 361-365
DOI : 10.36348/sjm.2019.v04i05.004
Background: We investigated the results of diagnostic coronary angiography and trends in rates of myocardial revascularization procedure included percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures in Gaza between 2015 and 2018. Methods: A descriptive retrospective study based on the analysis of all diagnostic coronary angiographies (CAG) based on the largest Ministry of Health hospital in Palestine Al- Shifa Hospital Report and the Center of Bureau of Statistics, to evaluate the annual rate of PCI and CABG volume have been done since January 2015 until January 2019. Results: A total of 4887 diagnostic coronary angiography procedures were performed. The mean age of patients was 58.0±10.2 years. A 3245 of cases were male (66.4%). A total of 5225 revascularization procedures (PCI: 4286, CABG: 939) were performed during the study period. From 2014 to 2018 the PCI volume increased by 94 % (80/100 000 to 155/100 000) (P < 0.0001), CABG volume decreased by 47 % (30/100 000 to 17 /100 000) (P <0.0001), PCI/CABG ratio increased from 2.7 to 9.1 (P< 0.0001). The indications for diagnostic coronary angiography were stable angina (57% of cases), non-ST-elevation acute coronary syndrome (NSE-ACS) in 24.0%, ST-elevation myocardial infarction (STEMI) in 19.0%. The diagnostic coronary angiography results showed significant lesions in 64.5% of patients. About 19.2% of total cases have three vessel disease, 21% have two vessel disease and 24.4% of them have one vessel disease. The segments most involved were Left Anterior Descending Artery (LAD) which was involved in 47.2% of cases. Discussion: We observed a dramatic increases in the total coronary revascularization procedures with a marked decrease in CABG and increase in PCI procedures in Gaza
Original Research Article
May 26, 2019
An In-Vitro Study Analysis Using Die Stones for the Dimensional Accuracy of Elastomeric Impression Material
K.Premnath, Nagaranjani Prakash, Kamala R, Sadananda M P, Syed Ahmed Rheel, B.P.G. Tilak
Page Numbers : 366-372
DOI : 10.36348/sjm.2019.v04i05.005
The impression materials are essential for the fabrication of stone casts and dies. The successful impression is based on the accuracy of impression material with respect to detailed reproduction and dimensional accuracy Differences in dimensional stability, wettability, and surface hardness are seen among various elastomeric impression materials. The purpose of repouring elastomeric impression material is to evaluate the accuracy of the material between different time intervals. At two different time interval with different types of die, stones poured for vinyl siloxanther elastomeric impression and additional silicone for the study to evaluate the dimensional accuracy material. The poor reproducibility, lack of surface details, and bubbles in the cast, which may lead to an inaccurate die and a poorly fitting prosthesis due to poor incompatible materials. Method: The study involves as per American dental association specification, using a stainless steel die nearly 90 impressions were taken, out of which 45 impressions were taken by each impression material, by pouring into 3 different die stones and equally subdivided into groups of 15 each. The statistical analysis was used for ANOVA test and TUKEY' POST – HOC TEST. A Computerized coordinated measuring system was used to assess various dimensions on stone cast poured from the impression of the stainless steel model. Group A, B, C: Indentium Medium poured with Ultrarock, Elite rock, Alpenrock. Group D, E, F: Monopren Transfer poured with Ultrarock, Elite rock, Alpenrock. Results: The result shows that Addition silicone yielded less accurate cast than formulated identium (vinyl siloxane ether). Conclusion: The study concluded that presence of a certain amount of variation at a time interval (15 min and 75 min) on impression repouring, henceforth indicates that when poured immediately better accuracy is seen, and newly formulated vinyl siloxane impression material yields more accurate impressions
Case Report
May 29, 2019
Paucisymptomatic Ovarian Pregnancy Diagnosed at the Moroccan Military Field Hospital in the Zaatari Camp for Syrian Refugees
Rachid Aitbouhou, Ilyas El Kassimi, Bouzroud Mohammed, Moulay Mehdi Hassani, Driss Moussaoui
Page Numbers : 373-375
DOI : 10.36348/sjm.2019.v04i05.006
Ovarian pregnancy accounts for 2 to 3% of ectopic pregnancies. It is independent of other usual extra uterine pregnancy risk factors. Its physiopathology remains unclear; it can evolve until the second trimester or even term. The diagnosis is difficult; it is often made perioperatively and confirmed by histology. Despite the progress of medical treatment, surgery remains the best way for therapeutic management. We report a case of paucisymptomatic ovarian pregnancy successfully managed at the Moroccan Military Field Hospital in the Zaatari Camp with a literature review
Original Research Article
May 30, 2019
A Study of Risk factors, Occurrence and aetiology of Catheter Associated Urinary Tract Infections (CAUTI) and Antibiotic Sensitivity Pattern from confirmed cases of CAUTI in a Tertiary care Hospital
Introduction: The urethral catheter is one of the most vulnerable of medical devices, having been used for urine retention on an intermittent or indwelling basis for centuries. Insertion of a catheter may carry urethral organisms into the bladder. Even with meticulous attention to maintenance of the closed system, the space between the external catheter and the urethral mucosa offers opportunity for bacterial entry directly into the bladder and are eliminated efficiently; most bacterial strains that enter the catheterized urinary tract are able to multiply to high concentrations within a day. The duration of catheterization is the most important risk factor for the development of catheter-associated bacteriuria. the present study was done to assess the risk factors, occurrence and aetiology of catheter associated urinary tract infections (CAUTI) in ICU of Dr D.Y Medical College, Hospital and Research centre, by various microbiological techniques and to determine the susceptibility pattern of isolates to commonly used antimicrobial agents for prophylaxis and empiric therapy of CAUTI in patients on indwelling catheter. Results: majority of the patients (17.3%) were in the age group of 61-70years followed by 41-50 years (16.2%), 51-60 years (16%), 21-30 (14.9%), 31-40 years (14.5%), 71-80 years (11.1%), 11-20 years (7.1%) and 81-90years (2.9%). The mean age of the patients was 49.21 ± 19.04 years. 62.5% patients were male and 37.5% were female. There was male preponderance and the M:F ratio was 1.67:1. It was observed that significantly higher number of patients (6.1%) patients had the indwelling catheter for 8-14 days. There was significant association of days of catheterization and CAUTI as per Chi-square test (p<0.05). The logistic regression analysis showed that days of catheterization were independently associated with CAUTI. Conclusion: The urinary tract of catheterized patients is highly susceptible to severe infection. This infection is associated varied microbiological aetiology. Antibiotic sensitivity pattern of the pathogen involved is also low. This along with existing underlying condition of comorbidities increases hospitalization, medication, morbidity and also adds to the financial burden. Therefore, it is imperative to carry out microbiological testing to determine aetiology and ascertain effective antibiotics. Emphasis should also be made on reducing the duration of catheterization in order to reduce the incidence of catheter-related UTI. Hospital-wide surveillance program and appropriate catheter care protocols should be developed and implemented from evidence-based protocol.
Case Report
May 30, 2019
Ketosis Diabetes and Hypertrygliceridemia Induced By L-Asparaginase Administered For the Treatment of Acute Lymphoblastic Leukemia (ALL)
M. Soussou, G. El Mghari, N. EL Ansari
Page Numbers : 385-388
DOI : 10.36348/sjm.2019.v04i05.008
Asparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL. We present the case of a 23-year-old patient who presented with fatigue, polyuria, polydipsia associated to a bronchial syndrome and fever with vomiting and abdominal pain. The patient was on chemotherapy for his acute lymphoblastic leukemia (ALL). Blood and urine examination confirmed the diagnosis of diabetic Ketosis. A hypertriglycedemia was also found. The etiology for this both complications was most likely a result of oral glucocorticoid therapy combined with asparaginase therapy. The patient was rehydrated with saline, and antibiotics were administered to treat his infection. He was then slowly brought to euglycemia with sub cutanous insulin injections. Although these complications are relatively rare during the treatment of ALL ( prevalence of 10%), frontline providers should be aware of these side effects because delayed diagnosis may lead to a more severe complications such as ketoacidosis or hyperosmolar hyperglycemia with risk of hypovolemic shock and death
Case Report
May 30, 2019
Perioperative Takotsubo Cardiomyopathy in Young Adult: A Case Report and Review of the Literature
Background: Tako-tsubo syndrome is an increasingly common cause of perioperative left ventricular dysfunction. It’s often transient and reversible. Until then, it mainly affect elderly patients but recently it begins to spread to a younger population. Case report: we report the case of a young female patient with takotsubo cardiomyopathy following a simple Laparoscopic abdominal surgery
Case Report
May 30, 2019
A Rare Case of Chronic Lymphocytic Leukemia in A Patient With Essential Thrombocythemia
Lina El Mekkoudi, Fatima Boukhchach, Kamal Doghmi, Mohammed Mikdame
Page Numbers : 395-397
DOI : 10.36348/sjm.2019.v04i05.010
Essential thrombocythemia (ET) and chronic lymphocytic leukemia (CLL) are 2 distinct, clonal hematologic malignancies. The association of ET and CLL is very rare, and only a handful of cases have been described in the literature, the pathogenic mechanisms of this phenomenon remain unclear. Here we describe a patient with an uncommon case of Janus Kinase 2 (JAK2) V617F positive ET treated by hydroxyurea and pipobroman, who eventually developed a second unrelated hematologic malignancy, CLL
Original Research Article
May 30, 2019
Isolated Congenital Central Hypothyroidism, A Frequently Missed Diagnosis
Nasir AM. Al -Jurayyan, Hala G.Omer, Hadeel Z Alsarraj, Abdulrahman N. A Al -Jurayyan and Sharifah DA. Al-Issa
Page Numbers : 398-402
DOI : 10.36348/sjm.2019.v04i05.011
Central hypothyroidism is a thyroid hormone deficiency due to a disorder of the pituitary, hypothalamus or hypothalamic -pituitary portal system, leading to diminished thyroid –stimulating hormone (TSH), thyrotropin–releasing hormone (TRH) or both. It has an estimated prevalence of approximately 1 in 100.000. It is rarely isolated and occurs more commonly in conjunction with other pituitary hormones deficiency as well as neurological signs. The clinical manifestations of isolated central hypothyroidism are usually non -specific and are often delayed or miss diagnosised. The diagnosis can be difficult and usually based on low level of free hormone (FT4) and low to normal level of thyroid –stimulating hormone (TSH). The diagnostic value of Thyrotropin –releasing hormone (TRH) test has been evaluated in such situation. The screening, in the majority relay on TSH measurement. In this article we describe three infants who were diagnosed with congenital isolated central hypothyroidism at the KKUH, Riyadh, Saudi Arabia during the period from January 2016 to April 2019, as pediatricans need to be aware of this rare condition to avoid diagnostic delay and to start the appropriate replacement therapy
Original Research Article
May 30, 2019
Visual Acuity Loss and Prevelance of Colour Vision Deficiency amongst Secondary School Students in Ogoja Urban, Cross River State, Nigeria
Sunday A. Bisong, Okot-Asi T. Nku-Ekpang, Rachel S. Usoro, Esu U. Enene
Page Numbers : 403-409
DOI : 10.36348/sjm.2019.v04i05.012
Visual acuity loss and colour defects among young adults often times occur without notice. The aim of this study was to determine the visual acuity status and colour defects amongst secondary school subjects in Ogoja urban of Cross River state, Nigeria. A descriptive cross-sectional study was conducted using the multi- stage sampling technique amongst 500 secondary school students in Ogoja urban. The standard Snellen’s chart was used to assess visual acuity. The Ishihara chart Plates 1-15 of the 2008 edition of the Ishihara’s colour album were used to detect colour defects. The mean age of the subjects was 13.33 ±0.12 years for the male subjects while that for the females was 12.83 ±0.16 years. The heights of the male subject was 165.01 ±1.22cm while that for the females was 153.53 ±1.24cm, with the males being taller than the females (p<0.001); but the body weights did not differ. The visual acuity did not differ between the male and female subjects. However, when the visual acuity was categorised, only 80 subjects (16.1%) for the right eye and 77 subject (15.5%) for the left eye had normal visual acuity (6/6 to 6/8). The bulk of the other subjects belonged to the categories of mild (6/9 to 6/18), moderate (6/19 to 6/48) to severe (6/49 to 6/60) impairment in visual acuity: 235(47.2%) and 238(47.8%) for the right and left respectively having mild visual impairment; 78(15.7%) and 78(15.7%) for right and left respectively having moderate visual impairment; severe visual impairment was seen in 105(21.1%) and 105(21.1%) for the right and left eyes respectively. The frequency of distribution of colour defects amongst the secondary school subject showed that 0.75% of the subjects studies were red colour blind while 2.46% of the subjects were red-green colour blind. Therefore, in this population with a perceived normal visual acuity, the percentage of subject with visual impairment seemed higher than those with normal visual acuity. It is not clear what could be responsible for this
Case Report
May 30, 2019
Rupture of A Giant Retro-Caval Aneurysm of the Right Renal Artery about A Case
H. Elloumi, M. Chtoutourou
Page Numbers : 410-413
DOI : 10.36348/sjm.2019.v04i05.013
We report the case of Mr IS 50 years old without notable antecedents, admitted in our service in a haemorrhagic table of shock associated with an abdominal mass giving the lumbar contact in connection with a broken aneurysm in the right renal artery associated with ipsilateral renal ischemia. A right nephrectomy was carried out and a subtotal resection of aneurysm with installation of a drainage. The operational continuations were simple. We review the literature regarding epidemiology, classification, symptomatology and management of aneurysms of the renal artery
