European Journal of Medical and Health Sciences https://ejmed.org/index.php/ejmed European Journal of Medical and Health Sciences European Open Access Publishing en-US European Journal of Medical and Health Sciences 2593-8339 Acute Rheumatic Carditis Manifesting As Complete Heart Block At Initial Presentation In A Young Male - A Rare Case Report https://ejmed.org/index.php/ejmed/article/view/336 <p>A 26-year male came to the emergency department with a history of syncope along with fever and joint pains of two weeks duration. The electrocardiogram showed a complete heart block (CHB). On further workup, the CHB appeared secondary to Acute Rheumatic Carditis (ARC). The CHB recovered over a week with anti-inflammatory therapy. This case shows that ARC can manifest with a complete heart block and syncope, which is reversible.</p> P. Praneeth N. Praveen A. U. Kiran N. Vijaya Lakshmi K. K. Anjani Copyright (c) 2020 P. Praneeth, N. Praveen, A. U. Kiran, N. Vijaya Lakshmi, K. K. Anjani http://creativecommons.org/licenses/by/4.0 2020-07-01 2020-07-01 2 4 10.24018/ejmed.2020.2.4.336 Evaluation of Reticulated Haemoglobin (CHr) as a diagnostic parameter in Iron Deficiency Anemia https://ejmed.org/index.php/ejmed/article/view/342 <p><em>Introduction</em>: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts of the world. In developing countries, the commonest cause is inadequate dietary intake [1]. The red cell indices raise the suspicion of iron deficiency state due to the microcytic, hypochromic changes and the wide red cell distribution width. The iron studies are confirmatory of an iron deficiency state, but are not accurate in the presence of infection, inflammation or malignancy as they are acute phase proteins and are affected in these states making the serum iron studies unreliable under these conditions. The reticulocyte haemoglobin content (CHr) indicates the iron available in the marrow for the production of Hb and are not affected by the above-mentioned situations and therefore has been recommended as a reliable marker of iron status in the body. The value for CHr given in the literature was 25pg [3].</p> <p><em>Objectives:</em> General objective was to evaluate the significance of CHr in the diagnosis of IDA. The Specific objectives were to compare CHr with the other conventional iron parameters including serum iron, serum ferritin, TS and TIBC and evaluate any significance of CHr with RBC indices (MCV, MCH and MCHC) and age.</p> <p><em>Methodology:</em> A retrospective analytical study performed at the Department of Haematology of a Tertiary care hospital in Sri Lanka. Data was obtained from the patient records of those referred to the Haematology department for management of iron deficiency during the period of 9 months commencing from April 2019 to January 2020. Data from 178 adult patients both males and females (16 to 84 years) diagnosed with IDA (S. Ferritin &lt; 20ng/ml) (Hb &lt; 12g/dl in men and Hb &lt;11.5g/dl in women) were randomly selected. In pregnant females the S. Ferritin level considered was &lt;30ng/ml and the Hb level was &lt;11g/dl in the first trimester and 10.5g/dl in the 2nd and third trimester [4]. Blood count and CHr was analyzed using Mindray fully automated analyzer BC 6800, Serum iron and TIBC was measured with Mindray BS 480 and Serum ferritin with Advia Centaur Xp. TS was calculated by dividing serum iron by TIBC and multiplying by 100. A data extraction sheet was used to enter the investigations with the results.</p> <p><em>Statistical Analysis: </em>Data were double entered and were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistical methods were used to calculate the median and the mean ± standard deviation of Hb, serum iron, serum ferritin, TIBC, TS, MCV, MCH, MCHC and CHr. Pearson’s correlation was used to evaluate the correlation between variables. Coefficient of determination (R Sq) was used to a statistical measure of how close the data are to the fitted regression line. P &lt; 0.05 was considered significant.</p> <p><em>Conclusion: </em>Significant positive correlations were observed between the CHr and haematological parameters such as Hb, MCV, MCH, and MCHC and biochemical parameters including serum iron, serum ferritin, and TS (p value &lt; 0.001). Negative correlation was seen between the CHr and TIBC and there was no correlation with age. The mean value of CHr was 22.4 ±4.16pg and median was 22.2 pg.</p> <p>&nbsp;</p> C. C. Kariyawasan D. J. U. S. Samarasekara N. Vithanage D. M. C. Dissanayake S. A. C. D. Ranatunga B. L. T. Balasuriy Copyright (c) 2020 C. C. Kariyawasan, D. J. U. S. Samarasekara, N. Vithanage, D. M. C. Dissanayake, S. A. C. D. Ranatunga, B. L. T. Balasuriy http://creativecommons.org/licenses/by/4.0 2020-07-01 2020-07-01 2 4 10.24018/ejmed.2020.2.4.342 Evaluation Of The Integrated Care Model: Child Morbidity Reduction In Mashonaland East, Zimbabwe https://ejmed.org/index.php/ejmed/article/view/354 <p>Zimbabwe has one of the highest prevalence rates on preventable child morbidity in the world. This is mainly attributable to the absence of an effective community health mobilisation structure that reaches all targeted households with correct and consistent social behaviour change interventions for better child and maternal health.</p> <p>To address this, a cluster randomised controlled trial was conducted to assess the effectiveness of a developed integrated community intervention approach in reducing child morbidity and improving maternal health outcomes. A total of 765 mother-child pairs (413 in the intervention and 352 in the control) from 2 districts in Mashonaland East province were recruited and followed up for 12 months. Only women with children aged 0 - 48 months at the beginning of the study were selected. Participants were selected (and recruited) through stratified random sampling from 30 villages/clusters (16 in the control and 14 in the intervention) out of the total of 43 villages in the 2 districts. The intervention arm received education on maternal and child health through an Integrated Care Model mobilisation system whereas participants in the control arm were mobilized and educated using the conventional mobilisation system. Baseline and end-line surveys were done to assess and compare baseline characteristics and secondary study outcomes. The primary outcome was child morbidity in the follow-up period of 12 months.</p> <p>The mean age of participating mothers was 28 years (SD = 6.8) and that of participating children was 18.2 months (SD = 4.0). The risk of child morbidity was 37.5% in the control and 22.0% in the intervention representing a relative risk of 1.7 [95% C.I (1.4-2.1)]. The incidence rate of child morbidity was 0.043 and 0.022 episodes per child year in the control and intervention arm respectively giving an incidence rate ratio of 2.0(p&lt;0.001). This ratio meant that the chance of being a disease case in the control was double that in the intervention arm. Women in the intervention arm had statistically significant (p&lt;0.001) higher knowledge about maternal and child health and better child care practices at the end of the study.</p> <p>There was strong evidence that the Integrated Care Model did not only reduce child morbidity but also improved maternal knowledge, health-seeking behaviour and care practices. Accordingly, governments in developing countries and countries in poor resource settings could strengthen their community health delivery systems by implementing this low-cost, sustainable and high-impact approach.</p> Maxwell Mhlanga Copyright (c) 2020 Maxwell Mhlanga http://creativecommons.org/licenses/by/4.0 2020-07-01 2020-07-01 2 4 10.24018/ejmed.2020.2.4.354 Conjunctival Botryomycoma: A Case Report https://ejmed.org/index.php/ejmed/article/view/334 <p>The fleshy telangiectatic bud or pyogenic granuloma is a tumor-like lesion that develops from chronic inflammatory situations of the conjunctiva or the eyelid. The chalazion represents one of the most frequent of these situations. We report the case of a child who presented, after a chalazion, a pyogenic granuloma, treated by surgical removal.</p> Mehdi Khamaily Joumany Brahim Salem Imane Tarib Sidi Dahi Mounia Bouchaar Rachid Zerrouk Yassine Mouzari Fouad El Asri Karim Reda Abdelbarre Oubaaz Copyright (c) 2020 Mehdi Khamaily, Joumany Brahim Salem, Imane Tarib, Sidi Dahi, Mounia Bouchaar, Rachid Zerrouk, Yassine Mouzari, Fouad El Asri, Karim Reda, Abdelbarre Oubaaz http://creativecommons.org/licenses/by/4.0 2020-07-01 2020-07-01 2 4 10.24018/ejmed.2020.2.4.334 Role Of Vitamin K Therapy In Prevention Of Vascular Calcification In Chronic Kidney Disease https://ejmed.org/index.php/ejmed/article/view/360 <p class="Abstract"><em><span lang="EN-US">Introduction</span></em><span lang="EN-US">: Matrix Gla protein (MGP) is a central calcification inhibitor of vascular wall. The biological activation of the calcification-inhibitory protein MGP can be achieved by simple administration of oral vitamin K.</span></p> <p class="Abstract"><em><span lang="EN-US">Aim</span></em><span lang="EN-US">: The study was conducted to assess the effect of vitamin k supplementation on vascular calcification and to evaluate its effect on MGA in hemodialysis patients.</span></p> <p class="Abstract"><em><span lang="EN-US">Materials and Methods</span></em><span lang="EN-US">: Forty adult patients with end stage renal disease (ESRD) on regular hemodialysis sessions, thrice weekly, were enrolled in the study and were randomly assigned into two groups. Vitamin K group consisted of 20 patients were given oral vitamin K at 10 mg after each session of dialysis for a duration of one year. No-Vitamin K group included 20 patients didn’t receive vitamin K. All patients were subjected to the following: Matrix Gla protein (MGP), in addition to, plain digital abdominal x-ray and doppler ultrasound. </span></p> <p class="Abstract"><em><span lang="EN-US">Results</span></em><span lang="EN-US">: After one-year of vitamin K supplementation, a significant increase in MGP levels in Vitamin K group (75.7±26 ng/mL) were noticed. There were no significant changes in CIMT and AACS in Vitamin K group after vitamin K supplementation in compared to their baseline levels, while the CIMT and AACS were significantly increased in No-Vitamin K group in compared to their baseline levels. </span></p> <p class="Abstract"><em><span lang="EN-US">Conclusion</span></em><span lang="EN-US">: Vitamin K supplementation could not stop vascular calcifications but significantly attenuate their progression.</span></p> Mohamed Farouk Ibrahim Mosa Ahmed Kamal Harfoosh Copyright (c) 2020 Mohamed Farouk Ibrahim Mosa, Ahmed Kamal Harfoosh http://creativecommons.org/licenses/by/4.0 2020-07-06 2020-07-06 2 4 10.24018/ejmed.2020.2.4.360 Community And Individual Factors Associated With Maternal And Neonatal Care Practices In Low Resource Settings. A Case Of Zimbabwe https://ejmed.org/index.php/ejmed/article/view/353 <p>Neonatal mortality has been increasing in Zimbabwe from 20/1,000 live births between 2000 and 2004 to 29 /1,000 live births between 2010 and 2014.Suboptimal newborn care practices are the predisposing factors to neonatal mortality. In Manicaland Province, care seeking behaviours for fever which is the main symptom of majority of infections in children and knowledge levels of danger signs that should cause the mother to take a child immediately to a health facility remains unacceptably lower than the national averages. A cross sectional descriptive and analytic design was carried out to explore the factors associated with the practice of the recommended newborn care practices by women of child bearing age in Mutare District. Health facilities were purposively sampled and participants were systematically sampled. Structured interviews were used to collect data which was analysed in Epi-Info version 7.2. Descriptive and multivariate analysis was performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breast feeding (62%), early initiation of Breast feeding (74%), good code care (73%), care seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Cultural practices that impact negatively on neonatal care in Mutare district include; asking for permission to seek treatment for the child when ill, feeding the baby immediately after delivery and applying substances and mixed traditional herbs on the cord stump of the newborn. Improving newborn care outcomes require approaches addressing demand and supply factors to reach communities with correct information on good newborn care.</p> E. Chiwawa M. Mhlanga A. Munodawafa F. Mukora-Mutseyekwa Copyright (c) 2020 E. Chiwawa, M. Mhlanga, A. Munodawafa, F. Mukora-Mutseyekwa http://creativecommons.org/licenses/by/4.0 2020-07-10 2020-07-10 2 4 10.24018/ejmed.2020.2.4.353 Degree of Deafness in the School for the Deaf in Akure, Ondo State, Nigeria https://ejmed.org/index.php/ejmed/article/view/361 <p>The various causes of deafness in children are not uncommon in our environment, despite global efforts on immunization against infectious diseases and other known predisposing factors to this hidden disability.&nbsp; Prevention of deafness must be a priority to all the stake holders. However, the need to know the degree of deafness among those in the school for the deaf so as to know those that can benefit from amplification via the use of high – tech hearing aid or cochlear implant cannot be over-emphasized; hence this study. A prospective study of deaf children in a school for the deaf was carried out over a 7-month period from July 2005 to January 2006 at the ENT Department, Ondo State Specialist Hospital, now University of Medical Sciences Teaching Hospital, Akure. A total of 311 pupils comprising 173 males and 138 females had screening and hearing aid trials. Age range was 7 to 20 years. A total of 64 pupils (20.6%) were moderately deaf, 32 pupils (10.3%) were severely deaf while 215 pupils (69.1%) were profoundly deaf. The use of hearing aids, timely cochlear implantation and other rehabilitation measures could bring the beneficiaries into the mainstream of formal education and improved post - qualification employment opportunities.</p> Manuwa Idown Akenroye Ambrose Akinbohun Copyright (c) 2020 Manuwa Idown Akenroye, Ambrose Akinbohun http://creativecommons.org/licenses/by/4.0 2020-07-10 2020-07-10 2 4 10.24018/ejmed.2020.2.4.361 “Home and Away” A look at Gulf Medical Students’ Influencing Factors, Challenges and Attitudes for Studying Medicine Abroad https://ejmed.org/index.php/ejmed/article/view/370 <p class="Abstract"><em><span lang="EN-US">Introduction</span></em><span lang="EN-US">: Higher education is no longer provided solely in the confines of national borders. Now days, the general trend is that students are no more reluctant to cross boundaries and travel to different places for achieving better education. Aim: To explore gulf medical students influencing factors, challenges, and perceptions to study abroad. </span></p> <p class="Abstract"><em><span lang="EN-US">Methods:</span></em><span lang="EN-US"> Cross sectional prospective study was conducted with self-administered survey which consisted of six sections. The survey was distributed by email to gulf medical students studying in four countries (United Kingdom, Ireland, Kingdom of Bahrain, and Jordan). Data were tubulated on Excel and analysed with SPSS V.22.</span></p> <p class="Abstract"><em><span lang="EN-US">Results:</span></em><span lang="EN-US"> Total responses received that met inclusion criteria were 94 with mean age of 20.89 (68.08% females). 51% of participants were from Kuwait, and 57% of participants were studying in European universities. Broadening personal experience was the main influencing factor to study abroad, and word of mouth from parents and students studying abroad were the main individual influences. Financial issues were the main challenges for studying abroad. Surgical specialities were the desired specialities for future career accounting for 44.7%.</span></p> <p class="Abstract"><em><span lang="EN-US">Conclusion</span></em><span lang="EN-US">: Understanding the underlying reasons behind a student’s decision to study abroad plays an important part on structuring scholarship and allocating resources. The high rate of students regretting studying abroad and at the same time the high rate of recommendation for other to study abroad indicate that personal satisfaction is a key factor, however, studying abroad does not suit everyone.</span></p> Hatem Al-Saadi Haya Malallah Humaid Al-Kalbani Jameela Al-Saadi Ahlam Al-Saadi Ghanim Al-Saadi Abdullah Al-Balushi Tariq Al-Saadi Copyright (c) 2020 Hatem Al-Saadi, Haya Malallah, Humaid Al-Kalbani, Jameela Al-Saadi, Ahlam Al-Saadi, Ghanim Al-Saadi, Abdullah Al-Balushi, Tariq Al-Saadi http://creativecommons.org/licenses/by/4.0 2020-07-10 2020-07-10 2 4 10.24018/ejmed.2020.2.4.370 Cardiovascular Complications Associated with COVID-19 Infection https://ejmed.org/index.php/ejmed/article/view/343 <p>COVID-19 has spread worldwide and caused pneumonia-like illness similar to that caused by SARS-CoV and MERS-CoV. Apart from lung injury, coronaviruses cause severe cardiovascular disorders. Studies have confirmed that COVID-19 uses angiotensin-converting enzyme 2 (ACE2) receptor to enter the host cell similar to SARS-CoV. ACE2 receptors are found in various body organs including lungs, heart in kidneys. The most common complication observed are acute respiratory distress syndrome, acute cardiac injury and cardiovascular disorders including myocarditis, cardiac arrythmias and myocardial infarction. It can also cause acute and chronic cardiovascular diseases. Almost 20% of patients progress to severe condition. Patients with underlying cardiovascular disorders have poor prognosis. It is believed that ACEI/ARBS can alleviate the cardiovascular problems in COVID-19 patients. Hence, the risk factors for cardiovascular disease and complications should be carefully considered.</p> Hassan S. Naji Copyright (c) 2020 Hassan S. Naji http://creativecommons.org/licenses/by/4.0 2020-07-10 2020-07-10 2 4 10.24018/ejmed.2020.2.4.343 Sutureless Intrascleral Fixation Of The Carlevale (Soleko) Intraocular Lens In The Correction Of Aphakia. Own Experience https://ejmed.org/index.php/ejmed/article/view/372 <p>The article evaluates the functional stability in the eye and the method of intrascleral fixation of spherical or toric, monofocal, intraocular Carlevale lens by Soleko. This procedure was performed in patients requiring correction of aphakia. Haptics of the one-piece lens, due to the T-shape structure are fixed intrasclerally and thus do not require additional fixation sutures. Intrascleral fixation was performed in 14 eyes, in 13 patients, between 2017 and 2019. In one case, a corneal astigmatism correction model (Carlevale toric) was used. Good visual quality and full intraocular stabilization were obtained. Except for transient vitreous haemorrhage, cormeal edema and elevated intraocular pressure, no adverse effects were observed, including intraocular displacement, subluxation or rotation of the lens relative to the axis. The normal and stable position of the leens was also obtained in the eyes with accompanying nystagmus.</p> Adam Cywinski Copyright (c) 2020 Adam Cywinski http://creativecommons.org/licenses/by/4.0 2020-07-10 2020-07-10 2 4 10.24018/ejmed.2020.2.4.372 Description of a Framework to Enhance Antiretroviral Therapy Adherence using Self-efficacy and Belief about Medicines https://ejmed.org/index.php/ejmed/article/view/357 <p class="Abstract">There is ample evidence that strict adherence to antiretroviral therapy (ART) is strongly associated with optimal health outcomes among people living with HIV (PLWHA), although strict adherence to treatment regime is exceedingly difficult in chronic medical conditions. The intention to adhere to ART among PLWHA is often influenced by individual adherence self-efficacy, along with their Beliefs about Medicines. Various studies have described the factors influencing adherence in ART, and most of these were guided by conceptual framework encompassing the relevant constructs of the Cognitive-Behavioural theory (CBT), in which health behaviour is viewed as a result of an individual’s conscious rational choice. Based on the results of an empirical study conducted among a cohort of PLWHA and the findings from the literature, this paper describes a framework for enhancing adherence to ART using the Self-Efficacy model and Belief about Medicines theory. These two constructs from the CBT have been widely used in studying patients’ adherence to long-term therapy in chronic medical conditions. The identified interconnected system of beliefs associated with ART adherence are used in developing an algorithm which will prompt a healthcare professional to initiate need-based interventions that seeks to reduce personal beliefs that are negatively influencing the person’s adherence to ART.</p> Adegoke Olusegun Adefolalu Copyright (c) 2020 Adegoke Olusegun Adefolalu http://creativecommons.org/licenses/by/4.0 2020-07-11 2020-07-11 2 4 10.24018/ejmed.2020.2.4.357 Novel Coronavirus (COVID-19) Outbreak In Nigeria: How Prepared Is The Radiography Sector? https://ejmed.org/index.php/ejmed/article/view/371 <p><em>Introduction</em>: Following the outbreak and increasing numbers of coronavirus (COVID-19) cases in Nigeria, healthcare professionals are at the forefront in dealing with the pandemic. Radiographers are among the first line care givers. The study is aim to assess the level of preparedness of the Radiography sector in Nigeria.</p> <p><em>Methods: </em>A prospective cross-sectional survey was conducted using self-completion questionnaire. The questionnaire was generated on the 26th of March 2020, using online Google forms consisting of closed and open ended questions. Paired t-test statistic was used to compare the difference between "Before and After" changes in departmental protocols, using the SPSS statistical software, version 20. Statistically significant level was set at 0.05.</p> <p><em>Results: </em>A total of 107 radiographers from across the country responded to the questionnaire. Of these, 78(72%) were male and 27.1% female, giving a male to female ratio of 3:1. Following the outbreak of COVID-19, 86% of the respondents report that there have been changes in the departmental procedures. Sixty-seven percent said "No" to the availability of an appointment system, guidelines to reduce human to human contact(57%) and auditing for suspected COVID-19 cases (58.9%). Only 16(15%) of the respondents had received emergency training towards the fight against COVID-19. Of these, 6(37.5%) were trained&nbsp; in patient care, only 1(6.3%) on emergency response while 9 (56.3%) received training in limiting human to human transmission.</p> <p><em>Conclusion:</em> Findings in this study, suggest inadequate preparedness, with evidence of inadequate provision of equipment (Mobile X-ray and Ultrasound machines) for the diagnosis and management of cases in departments and isolation centers. In addition, emergency training on COVID-19 issues is low. The foregoing calls for adoption of urgent and immediate remedial measures.</p> <p><em>Implications for practice</em>: This study identify areas of practice that may detract from achieving optimum service delivery and safety during the pandemic.</p> G. M. Akpaniwo D. A. Olushola M. C. Okoji N. O. Egbe Copyright (c) 2020 G. M. Akpaniwo, D. A. Olushola, M. C. Okoji, N. O. Egbe http://creativecommons.org/licenses/by/4.0 2020-07-11 2020-07-11 2 4 10.24018/ejmed.2020.2.4.371 Wits Appraisal Among Qatari Females: A Comparative Study https://ejmed.org/index.php/ejmed/article/view/365 <p><em>Introduction</em><em>:</em> The goal of cephalometric analysis is to determine the skeletal and dental relationships that exist in an individual patient. The objectives of the present study were to establish the Wits appraisal for Qatari females and to compare the results with previous reported results in different racial groups.</p> <p><em>Materials and Methods</em>: The sample consisted of 34 lateral cephalometric radiographs of Qatari female patients with age range from18 to 25 years old presented with well-balanced face and acceptable profile.&nbsp;</p> <p><em>Results</em>: The mean value of the Wits appraisal for Qatari females in the present study was -0.62 ± 3.8. The Wits appraisal mean value of the present study revealed that no statistically significant difference between the Qatari females and the original data of Jacobson.&nbsp; On the other hand, significant differences were found when compared to other populations from several reports.</p> <p><em>Conclusion</em>: The Wits appraisal among Qatari females was -0.62 with standard deviation of 3.8. Care should be taken in growing and developing children where variation in dental height exists and may confuse the Wits value. The Wits appraisal could be used as a moderator to ANB angle in boarder line cases. It is recommended to incorporate angular measurements using 3D imaging software which increases diagnostic accuracy for the least amount of existed discrepancy. </p> Hayder Abdallah Hashim Najah AL-Sayed Feras Abed AL Jawad Ayah AL-Qaisi Copyright (c) 2020 Hayder Abdallah Hashim, Najah AL-Sayed, Feras Abed AL Jawad, Ayah AL-Qaisi http://creativecommons.org/licenses/by/4.0 2020-07-11 2020-07-11 2 4 10.24018/ejmed.2020.2.4.365