European Journal of Medical and Health Science European Journal of Medical and Health Sciences European Open Science Publishing en-US European Journal of Medical and Health Science 2593-8339 Epidemiological Profile of Diabetes Mellitus Patients in Diabetes Center in King Salman Specialist Hospital Hail Region Saudi Arabia <p><em>Objective:</em> To investigate the degree of association between the specific epidemiologic factors of diabetes in the Hail Region of Saudi Arabia.</p> <p><em>Methodology:</em> The research is considered a case study using information from the King Salman Specialist Hospital in Hail Saudi Arabia. 5000 Medical reports and records were used in the retrospective cross-sectional study. Data analysis was done using SPSS statistical software.</p> <p><em>Results:</em> The Chi-square results indicated an insignificant association between gender and follow-up status (P &gt; 0.05). Both males and females sought treatment equally, whether follow-up or new treatments (P &gt; 0.05). There was a significant association between gender and diabetes type.</p> <p>The t-test results had varied results for the differences in age, BMI, and diabetes treatment. Age differences had no significant impact on the prevalence of diabetes among males and females (t (4998) = -0.63, P &gt; 0.05. Men had lower glycohemoglobin levels (8.11) differed significantly from that of women (8.58) t (4786) = -10.62, p &lt; 0.05. also, the creatine levels were higher in females than males. There were significant differences in low-density lipoprotein, hemoglobin, and BMI between men and women.</p> <p><em>Conclusions: </em>The findings indicated differences in treatment such as unawareness of insulin injection, ignorance of health practices and unhealthy dietary habits, gender-related disparities, the inheritance of genes through which the disorder manifests, and exposure to environmental factors triggering and exacerbating the condition. Future studies should consider the genetic dimension Diabetes.</p> Waffa Aswaq Al-Shammari Mosa Al-Ateeq Suad Al-Shubrami Abdullah Al- Jabreen Mona Al-Shammari Mashael Al-Jasir Copyright (c) 2021 Waffa Aswaq Al-Shammari, Mosa Al-Ateeq, Suad Al-Shubrami, Abdullah Al- Jabreen, Mona Al-Shammari, Mashael Al-Jasir 2021-03-02 2021-03-02 3 2 1 6 10.24018/ejmed.2021.3.2.516 Correlates of Actual and Self-Reported Knowledge and Skills, Attitudes, and Barriers Mitigating Against the Implementation of Evidence-Based Practice in Physiotherapy <p><em>Background: </em>Evidence-based practice (EBP) has in the last decade gained global prominence in healthcare professions including physiotherapy. Several studies have been conducted worldwide to determine physiotherapists' knowledge, attitudes, beliefs, behaviors, skills, and resources, and barriers mitigating against the implementation of EBP in physical therapy, but there is limited information on the correlation among actual (competence) and self-report (perceived) knowledge and skills about EBP.</p> <p><em>Methods:</em> This cross-sectional study investigated the premise of these associations among 233 Nigerian physiotherapists who completed a previously validated 55-item questionnaire that assessed demographic data, actual and self-report knowledge, skills and resources, attitudes, and barriers about EBP.</p> <p><em>Result:</em> We found no significant relationship between actual knowledge of EBP and clinical experience (r=.086, p&gt;.05), age (r=.048, p&gt;.05), academic degree (r=.108, p &gt;.05), self-reported knowledge (r=.097, p&gt;.05), and self-reported skills about EBP (r=.095, p&gt;.05). Demographic variables (age, years of clinical experience, and academic degrees) and psychosocial factors (self-reported knowledge, skills and resources, attitudes, and barriers about EBP) are not a significant predictor of actual knowledge of EBP.</p> <p><em>Conclusion:</em> The physiotherapists perceived that they are competent about EBP but in reality, they are not, and may fail to seek educational resources that will improve their understanding and improve their skills about EBP.</p> Joseph Balogun Chidozie E. Mbada Adetoyeje Y. Oyeyemi Faith A. Awoleye David B. Olakorede Adetutu Balogun Copyright (c) 2021 Joseph Balogun, Chidozie E. Mbada, Adetoyeje Y. Oyeyemi, Faith A. Awoleye, David B. Olakorede, Adetutu Balogun 2021-03-03 2021-03-03 3 2 7 11 10.24018/ejmed.2021.3.2.704 Study on Socio-Demographic Profile of Peptic Ulcer Disease in A Tertiary Care Teaching Hospital, Dhaka, Bangladesh <p><em>Background:</em> The prevalence and socio-demographic factors of peptic ulcer disease (PUD) have changed remarkably now a day. Currently, peptic ulcer disease has considered as a multifactorial health problem.</p> <p><em>Objective:</em> To determine the socio-demographic factors of Peptic ulcer disease among patients attending Bangladesh Medical College, Dhanmondi, Dhaka, Bangladesh.</p> <p><em>Methods:</em> This is a hospital-record based cross sectional descriptive study executed in a tertiary care teaching hospital, Dhanmondi, Dhaka. The study group comprises 200 PUD patients enrolled in our Bangladesh Medical College Hospital from July 2019 to December 2020. Analysis of data was done by using SPSS 15 software. Prevalence of PUD patients among study population was calculated by using percentage and the strength of association of socio- demographic factors were evaluated in our study.</p> <p><em>Results:</em> Total prevalence of PUD among the studied group was 83.5%; gastric ulcer 54.5% and duodenal ulcer 29%. Majority 56% were female patients in the age group of 41-50 years. Most prevalent endoscopic finding was erosive antral gastritis (48.50%). PUD was diagnosed predominantly among unemployed population (48.50%) in the urban locality (62%). The cardinal features were pain precipitated by certain food (55.69%) and loss of appetite (52. 09%).Regarding risk factors spicy food (55.69%) has secured the first position in our study followed by smoking (34.13%) and stress (18.56%).</p> <p><em>Conclusion:</em> Multifactorial variables were considered as risk factors for PUD. Population based endoscopic studies can detect PUD at its earliest possible stage and create awareness among population to prevent its further progression.</p> Sadia Saber Mohammed Tarek Alam Mohammad Monower Hossain Rafa Faaria Alam Copyright (c) 2021 Sadia Saber, Mohammed Tarek Alam, Mohammad Monower Hossain, Rafa Faaria Alam 2021-03-14 2021-03-14 3 2 12 15 10.24018/ejmed.2021.3.2.729 Flawed Studies of SIMS’s Diagnostic Accuracy by Teams of Puente-López and Capilla Ramírez <p><em>Background: </em>The teams of Puente-López and Capilla Ramírez evaluated diagnostic accuracy of the Structured Inventory of Malingered Symptomatology (SIMS), a test often used to assess malingering by persons injured in motor vehicle accidents (MVAs). Yet all SIMS items represent legitimate medical symptoms, and more than 50% of them are those experienced by severely injured motorists, but they are fallaciously scored as indicative of malingering. Thus, more injured patients with more symptoms obtain higher SIMS scores for malingering.</p> <p><em>Method: </em>The studies by Puente-López and by Capilla Ramírez were carried out on SIMS scores of injured motorists. The present article assesses the severity of their injuries, as documented by Puente-López and by Capilla Ramírez.</p> <p><em>Results and Discussion: </em>The study by Capilla Ramírez’s team excluded patients with pathological results on physical examinations, or on X-Rays, EMG, and MRI: thus, only mildly injured motorists were included. The patients of Puente-López had signs of only a mild cervical whiplash. Almost none reported lower back pain or dizziness. Thus, both studies included patients with only mild symptoms that resulted in very low SIMS scores: they scored within the non-malingering range as defined by the SIMS manual. Their scores were below SIMS scores of healthy persons instructed to feign whiplash symptoms from an MVA. The teams of Capilla Ramírez and of Puente-López erroneously interpreted these results as demonstrating diagnostic accuracy of the SIMS for detection of malingering in injured motorists.</p> <p><em>Conclusions: </em>The two studies of very mildly injured motorists fail to demonstrate “diagnostic accuracy of the SIMS” because the SIMS is mostly used by insurance contracted psychologists on more severely injured MVA patients (those with whiplash and post-concussion syndrome), i.e., those with more symptoms and thus, with higher SIMS scores that fallaciously classify them as “malingerers.”</p> Zack Z. Cernovsky Copyright (c) 2021 Zack Z. Cernovsky 2021-03-14 2021-03-14 3 2 16 23 10.24018/ejmed.2021.3.2.730 Medical School Applicants’ Online Interviews during COVID-19 Epidemic <p><em>Background</em>: For many years, the primary criterion used to select medical school applicants worldwide has been cognitive measures of high school educational attainment. Yet academic assessment alone may not necessarily select the candidates who possess the behavioral or non-cognitive attributes thought important in medical students and doctors: honesty, integrity, flexibility, motivation, willingness to cooperate, managing emotions, self-esteem, control, leadership skills, resilience personal values, confidence, empathy, conscientiousness, and&nbsp;social accountability. There is evidence that significant relationship exists between both cognitive and non-cognitive variables and students’ performance in medical school. The challenge posed by the current pandemic of covid19 is that all admission interviews are now carried out via video.</p> <p><em>Method:</em> In video interviews for admission to our Arabian Gulf University, the applicants were asked standardized questions under four main domains: motivation and commitment to medicine, handling stress and ethical dilemma, social skills, and responsibility as well as self-presentation. Each of these domains was given a Likert score ranging from one to five. Scores 1 and 2 indicated unsatisfactory performance, while scores 3, 4 and 5 indicated fair, good, and excellent, respectively. Each panel member scored each applicant independently. This creates the data bases for statistical analyses.</p> <p><em>Results and Discussion:</em> The feedback from staff and students was so far positive, however, statistical results need a longitudinal follow-up of at least one decade: we do not have statistics showing to what extent the selection criteria for admission have a predictive validity for successfully completing the MD program and performing as a medical doctor.</p> <p><em>Conclusions:</em> Transitioning medical school interviews to a virtual setting beyond the restrictions of COVID-19 would allow eliminating travel expenses and cost saving for applicants.</p> Mariwan Husni Reginald Sequeira Abdelhalim Deifalla Copyright (c) 2021 Mariwan Husni, Reginald Sequeira, Abdelhalim Deifalla 2021-03-15 2021-03-15 3 2 24 27 10.24018/ejmed.2021.3.2.731 Impact of Divorce and Separation for the Women with Spinal Cord Injury in Community Reintegration <p><em>Introduction:</em> Marriage is a lawful agreement between a man and woman. They can share their rights and responsibilities under the provision of Law, whereas divorce or separation is dissolving these bonds between married couples. Among Spinal Cord Injury patients this divorce or separation rate is high in Bangladesh.</p> <p><em>Objectives:</em> The main aim of this study was to identify the impacts of divorce and separation for the women with spinal cord injury during community reintegration.</p> <p><em>Methodology: </em>This was a mixed-method-type of study where the participant’s demographics data were analyzed by quantitative analysis by using a standard developed questionnaire (CIQ-R) and semi-structured open ended questionnaire to explore the best possible feedback from the participants for maximum 25-minutes duration. The present study conducted with 39 women participants since July 2011 to June 2016 at the CRP. Data were analyzed by SPSS 20 version.</p> <p><em>Result:</em> Total community integration score was 12.03 and SD was ± 3.87. This score was significantly lower to compare other study for person with SCI. The mean and SD of home integration (2.89, ±1.53), social integration (3.74, ±1.16), productivity (3.12, ±1.81) and electronic social networking (2.54, ±1.86) scores were also lower than the other study. Age, education, occupation, religion, living area, monthly income, marriage before or after injury, duration of marriage, number of children, duration of divorce or separation, ASIA, neurological level was found to be significant predictors of divorce or separation. Four major themes were found in this study (1) Causes of divorce and separation (2) Impact on relationship with family member (3) Impact on social participation (4) Impact on productive activities. Regardless of all participants reported loss of autonomy and functional ability, loss of sex life, loss of self-identity, loss of intimacy within laws, loss of autonomy were the main causes of divorce and separation.</p> <p><em>Conclusion:</em> Participants scored low in total community integration was lower than compare to other. Suggesting there is a great need to develop interventions by governmental and non-governmental organizations to better integrate individuals of women with divorce and separation with spinal cord injury in the community.</p> Farjana Taoheed Md. Obaidul Haque Shamima Islam Nipa Rakib Husain Muhammad Millat Hossain Apurbo Roy Md. Shahoriar Ahmed Copyright (c) 2021 Farjana Taoheed, Md. Obaidul Haque, Shamima Islam Nipa, Rakib Husain, Muhammad Millat Hossain, Apurbo Roy, Md. Shahoriar Ahmed 2021-03-15 2021-03-15 3 2 28 34 10.24018/ejmed.2021.3.2.690 Can 2-Aticyto Complex be an Effective Agent for Recovery of The Symptoms and Enhancing Laboratory Parameters in COVID-19 Patients? <p><em>Background:</em> SARS-CoV-2 (Covid-19) pandemic which was firstly identified in Wuhan/China in December 2019.There still exists no precise treatment for this pandemic yet despite many agents are tried in prophylaxis and treatment for Covid-19. In this study, we aimed to investigate the efficacy of 2-aticyto complex in clinical course in these patients.</p> <p><em>Materials and Methods</em>: 150 patients who applied to the Infection Diseases Polyclinics between dates September 2020-November 2020 having diagnosed with Covid-19 were included in our study. The patients were randomized into 2 groups (75 in each group) of which the first group only had the treatment of National Guideline and the second group had Viruthol® including 2-aticyto complex (at the dose of 27000 mcg/day) in addition to the treatment of the National Guideline. The laboratory parameters, clinical outcomes and the first day on which PCR result turned into negative of the patients were compared.</p> <p><em>Results:</em> In Viruthol® group, LDH, CRP, D-Dimer and ferritin levels were significantly decreased compared to the control group, while lymphocyte levels were higher. (p=0.02, p=0.001, p=0.01, p=0.02, p=0,001 respectively).&nbsp; In addition to that, clinical symptoms such as fever, headache, weakness, loss of taste and smell and muscle-joint pain recovered more rapidly in contrast with the control group (p=0.001, p=0.05, p=0.001, p=0.001, p=0.001, respectively). PCR results of the Viruthol® group turned negative in a statistically significant shorter period of time with respect to the control group (p=0.001).</p> <p><em>Conclusion:</em> Viruthol® containing 2-aticyto complex may be an agent that can be used both symptomatic treatment and improving the clinical situation and recovery of the patients followed up for Covid-19.</p> Ferhan Kerget Buğra Kerget Alperen Aksakal Abdullah Osman Koçak Copyright (c) 2021 Ferhan Kerget, Buğra Kerget, Alperen Aksakal, Abdullah Osman Koçak 2021-03-20 2021-03-20 3 2 35 39 10.24018/ejmed.2021.3.2.745 Symptom Profile of Injured Motorists on the Structured Inventory of Malingered Symptomatology <p><em>Background: </em>Recent extensive content analyses demonstrated that the items of the Structured Inventory of Malingered Symptomatology (SIMS) have no capacity to differentiate malingerers from legitimate medical patients: all items list or assess legitimate medical symptoms. We examined which SIMS items are the most frequently endorsed by injured motorists.</p> <p><em>Method:</em> De-identified archival data of 23 survivors (mean age=38.0, SD=12.8) of high impact motor vehicle accidents (MVAs) contained their SIMS scores, their responses to the Brief Pain Inventory, Morin’s Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, and to the Post-MVA Neurological Symptoms scale.</p> <p><em>Results:</em> All SIMS items which were endorsed by more than 43% of the patients in the directions scored by the SIMS as indicative of “malingering” were selected. Twenty-five items met this criterion. On a closer examination, all these 25 items are legitimate psychological and neuropsychological symptoms typically experienced by injured motorists, such as depression, impaired sleep, and postconcussive symptoms (memory and concentration problems, impaired balance) and whiplash symptoms (numbness in the limbs, instances of reduced muscular control over some of the limbs).</p> <p><em>Discussion and Conclusions:</em> The 25 endorsed items are consistent with the polytraumatic symptom profile of injured patients. In a travesty of psychological assessment, these symptoms are scored in the SIMS as denoting “malingering”.&nbsp;</p> Zack Z. Cernovsky Copyright (c) 2021 Zack Z. Cernovsky 2021-03-20 2021-03-20 3 2 40 43 10.24018/ejmed.2021.3.2.739 Notable Variants of SARS-CoV-2 <p>The current coronavirus pandemic has brought many deaths and affected economies around the world. The causative agent of COVID-19 is identified as SARS-CoV-2, a close relative to SARS-CoV that caused an outbreak of severe acute respiratory distress in 2002-2003. During the course of the pandemic, there has been many reports of mutations that occurred to SARS-CoV-2 with several lineages that has been identified around the globe. In this paper, a summary of the notable variants of SARS-CoV-2 is discussed.</p> Hassan Naji Copyright (c) 2021 Hassan Naji 2021-03-20 2021-03-20 3 2 44 47 10.24018/ejmed.2021.3.2.742 Frequency of Formication Symptoms in Injured Motorists and in Normal Controls <p><em>Background:</em> Formication is the sensation or feeling as if insects were crawling on or under the skin. It is observed in a variety of clinical situations including drug intoxications, multiple sclerosis, and diabetic neuropathy, among many others. Furthermore, it can be associated with injuries incurred during motor vehicle accidents (MVAs). We examined the frequency of reports of formication in a normal control sample as well as in a sample of motorists who sustained concussive and whiplash injuries following high impact MVAs. We also evaluated the correlations of the formication to measures of pain, insomnia, and of various post-accident neuropsychological symptoms.</p> <p><em>Method:</em> De-identified data on 23 injured motorists (mean age=38.0 years, SD=12.8) and on 20 normal controls (mean age 42.8 years, SD=19.9) were available. All motorists responded to the following True/False item: “I have pain in my body which seems to feel like bugs crawling under the surface of my skin.” Their data were also available on the Brief Pain Inventory, Post-MVA Neurological Symptoms (PMNS) scale, Insomnia Severity Index, and on the Rivermead Post-Concussion Symptoms Questionnaire. The data of normal controls included responses to the following specific item of the formication questionnaire: “Do you sometimes have an annoying feeling in some of your limbs or in some other part of your body as if insects were crawling on or under your skin?” The participants were to circle one of the following responses: “never, very rarely, sometimes, often, or almost constantly.”</p> <p><em>Results and Discussion</em>: Almost a third (30.4%) of the motorists who sustained whiplash trauma in their MVA reported the formication. In contrast, only one of the 20 normal controls (i.e., 5%) reported formication (this was an elderly man with MRI documented pathology in lumbosacral spine). Notably,&nbsp;formication correlated significantly with the ratings of “reduced feeling in the limbs” (r=.55, p=.010), but not with ratings of “tingling in the limbs” (r=.21, p&gt;.05).</p> <p><em>Conclusion:</em> The painful form of formication has been reported by almost a third of motorists who sustained whiplash injuries in their accident.</p> Zack Z. Cernovsky Varadaraj R. Velamoor Stephan C. Mann L. Kola Oyewumi James D. Mendonça Larry C. Litman Copyright (c) 2021 Zack Z. Cernovsky, Varadaraj R. Velamoor, Stephan C. Mann, L. Kola Oyewumi, James D. Mendonça, Larry C. Litman 2021-03-26 2021-03-26 3 2 48 52 10.24018/ejmed.2021.3.2.751 Cystic Adenoid Carcinomas in Ear, Nose and Throat: Unusual Localizations and a Literature Review <p><em>Introduction:</em> adenoid cystic carcinoma account 1% for all cancers of the ear nose and throat. Despite slow growth, their recurrence is frequent. This study concerns 5 cases of cystic adenoid carcinoma with atypical ear nose and throat locations (outside the main salivary glands).</p> <p><em>Materials and methods</em>: Our work is a study of 5 cases of cylindromes with atypical localizations collected at the ear nose throat and cervico-facial surgery department of Mohamed IV university hospital of Marrakesh: 1 case located at the external auditory meatus, 1 case at the infratemporal fossa, 1 case on the inside of the cheek, 1 case in the soft palate and one laryngotracheal case.</p> <p><em>Results and discussion</em>: The management of adenoid cystic carcinoma remains delicate because of their insidious growth, their neurological tropism and their metastatic potential. These associated elements delay the diagnosis that is often made while those tumors are locally advanced, which can make surgery difficult, and be responsible of a lot of late recurrences. The treatment of these tumors has long relied on exclusive surgery. Cystic adenoid carcinomas were considered radio resistant. Retrospective studies have shown the benefit of treatment combining surgery and radiotherapy, in terms of local control and disease-free survival, compared to surgery or radiotherapy alone.</p> <p><em>Conclusion:</em> The essential problem of adenoid cystic carcinoma remains the long-term control of the disease. Our results confirm that the gold-standard treatment should be both surgery and radiotherapy.</p> F. Hadid M. Hakimi O. Oulghoul O. Benhommad Y. Rochdi A. Raji Copyright (c) 2021 F. Hadid, M. Hakimi, O. Oulghoul, O. Benhommad, Y. Rochdi, A. Raji 2021-03-26 2021-03-26 3 2 53 59 10.24018/ejmed.2021.3.2.752 Trends in Lassa Fever Outbreak in Plateau State Nigeria <p><em>Background:</em> Since the first case of Lassa fever was reported in Plateau State, Nigeria in 1969, several outbreaks have occurred, and many more cases are being reported every year. This study aimed to describe the trends in Lassa fever outbreak in Plateau State, Nigeria from 2015 to the first half of 2019.</p> <p><em>Methodology:</em> A time series study was carried out employing a retrospective analysis of records of Lassa fever cases (from January 2015 – June 2019) obtained from Plateau State Epidemiological Unit. Cases were identified using the WHO case definition. Age-adjusted cumulative incidence, case positivity and case fatality rates were calculated for each year to study the trends. Data were retrieved and analyzed using Microsoft Excel.</p> <p><em>Results:</em> Cases were mainly of the younger age group and were more concentrated in the Northern senatorial zone. Despite the increasing trend in incident cases from 5 in 2015 to 126 in 2019, and age-adjusted cumulative incidence from 1 case per 10,000 population in 2015 to 348 per 10,000 population in 2019, case fatality rate showed a downward trend from 29.6% in 2016 to 12.9% in 2019. Case positivity rates varied from 27.3% to 34.1% to 19.4% and back to 27.3% from 2016 to 2019, and the cumulative Case Positivity Rate was 25.7%.</p> <p><em>Conclusion:</em> The incidence of Lassa fever in Plateau State showed an increasing trend while that of mortality was on a downward trend. More efforts should be put in place by the State government and other stakeholders to reduce the burden of this disease.</p> Elizabeth O. Okoh Simji S. Gomerep Esther A. Envuladu Yetunde O. Tagurum Adokole F. Okoh Amina Mohammed Ayuba I. Zoakah Copyright (c) 2021 Elizabeth O. Okoh, Simji S. Gomerep, Adakole O. Okoh 2021-03-27 2021-03-27 3 2 60 67 10.24018/ejmed.2021.3.2.757 Knowledge, Attitudes, and Practices of Patients on COVID-19 Epidemic Attending a Primary Health Care Setting Durban, South Africa <p>There is no proven specific treatment or adequate vaccination roll out against COVID-19 infection in South Africa. Optimal infection control measures encompass primary intervention to minimize the spread of COVID-19. Public knowledge, attitude, and practices of dealing with this highly infectious respiratory disease play a vital role in limiting the spread of the infection. Aim was to identify knowledge, attitudes, and practices gaps on COVID-19 pandemic for possible health education intervention. The objectives were to determine the knowledge, attitude and practices of out-patients attending a primary health care facility. A cross-sectional descriptive survey was conducted. The Student’s t-test and ANOVA test were carried out to determine the different mean scores for knowledge, attitudes and practices. Pearson’s correlation test was conducted to determine the relationship between knowledge, attitudes, and practices scores. Binary logistic regression was undertaken to determine the predictor of good knowledge, positive attitude, and preventive practices. A total of 345 out-patient attendees participated of which 51% were male. Over half (52%) of respondents were evaluated as having good knowledge, 59% as having positive attitudes and almost all (95%) were practicing prevention of COVID-19. The knowledge of the respondent was correlated with preventive practices (r=.173, p&lt;0.05). Multiple regression showed that respondents in the age groups 35-44 years and 45-54 years were 2.8 times and 5.7 times more likely to have good knowledge respectively. Non-smokers were 79% less likely to have good knowledge (OR=.219, p&lt;0.05). Respondents with no comorbidity were 50% less likely to have good knowledge (OR=.503, p &lt;0.05), when compared to those having co-morbidities. Respondents with the highest level of education was found to be positive predictor of positive attitudes (OR =7.3, p &lt;0.05). Primary Health Care users have poor knowledge, negative attitudes but practiced properly for the prevention of the transmission of COVID-19. Mass education is required to educate communities to improve knowledge and attitudes on COVID-19 epidemic in SA.</p> A. M. Hoque S. Buckus M. Hoque A. B. M. Mahbub Alam M. E. Hoque N. Singh Copyright (c) 2021 A. M. Hoque, S. Buckus, M. Hoque, A. B. M. Mahbub Alam, M. E. Hoque, N. Singh 2021-03-27 2021-03-27 3 2 68 73 10.24018/ejmed.2021.3.2.758 Clinical Medical Students’ Preferred Teaching Methods: A Study at the National Defense University of Malaysia <p><em>Background:</em> Providing appropriate teachings in the curriculum have a great impact on learning by the students.</p> <p><em>Objectives:</em> The aim of this study was to determine the clinical undergraduate medical students’ preferred teaching methods provided by the medical educators.</p> <p><em>Material and Methods:</em> This study was conducted on 89 medical students in the 4th and 5th year of the Faculty of Medicine and Defense Health, National Defense University of Malaysia, from 1st November 2019 to 31st July 2020. Each of the students was approached with a structured questionnaire for their responses to determine their preferred teaching methods.</p> <p><em>Results:</em> Out of 89 students, 46 were male (51.7%); the mean age of the study students was 23.5 years. Among the various teaching methods, bedside teaching was the most preferred (76.4%) one followed by lectures (14.6%), tutorials (7.9%) and seminars (1.1%). 66.3% of students would use e-learnings’ uploaded teaching materials, whereas the remainder would not. Bedside demonstrations of clinical skills by the tutors were preferred by 77.5% of students. Practicing clinical skills by the students on a real patient rather than on a mannequin or a simulated patient was preferred by 94.4% of students. Regarding case discussions, problem-based learnings (PBL) were preferred by 80% of students.</p> <p><em>Conclusions:</em> Bedside teachings, demonstrations of clinical skill by a teacher, practicing skills by the students on a real patient rather than on a simulated patient or a mannequin, and PBLs are highly preferred by the students. Adequate teaching materials uploaded in the e-learning management system provide a good source for the teachings and learnings.</p> Sheikh Salahuddin Ahmed Sagili Chandrasekhara Reddy Copyright (c) 2021 Sheikh Salahuddin Ahmed, Sagili Chandrasekhara Reddy 2021-03-30 2021-03-30 3 2 74 78 10.24018/ejmed.2021.3.2.762 How Micro Current Created by Grounding Stimulates Meridian Points in Acupressure? <p>Acupressure in Oriental medicine is used as a core therapeutic method due to its therapeutic efficacy and minimal side-effects. However, microcurrent stimulation, combined with acupressure and grounding, has not been studied under acupressure conditions in terms of how this combination might affect acupressure therapy's effectiveness. This paper clarifies the new concept of acupressure stimulation combined with a microcurrent that generates electron flow during earthing. In grounding the body, there is free electron movement from and to the body that creates microcurrent. Acupressure uses these currents to activate specific acupoints for therapeutic purposes and activating these acupoints adjust the imbalance between Qi across channels (meridians) and ultimately treat diseases. It is time for proper research and implementation of this technique to increase acupressure efficacy and reduce society's cost.</p> Madiha Khalid Jeremy Madvin Copyright (c) 2021 Madiha Khalid, Jeremy Madvin 2021-03-31 2021-03-31 3 2 79 83 10.24018/ejmed.2021.3.2.749 Commentary: Ethnocentric Considerations in the Allocation of Vaccines in Africa <p>This paper suggests that, just as the world community is concerned with ‘vaccine nationalism’ in the acquisition and distribution of vaccines, it should also be concerned with ‘vaccine tribalism’ in the respective African nations. This call is made because, African nations do not have impressive records of ethical distribution and apportionment of scarce resources, be it the delivery of healthcare services, medical doctors, or the national wealth, jobs, and the siting of national projects. Ethnocentric considerations, cronyism, big-man-ism, power, often trump ethical values of beneficence, non-malfeasance, equity, and fairness.</p> Ishmael D. Norman Copyright (c) 2021 Ishmael D. Norman 2021-03-31 2021-03-31 3 2 84 86 10.24018/ejmed.2021.3.2.714 Existence and Implications of Women Who Have Sex with Women in Tanzania: A Public Health Perspective <p>Women who engage in sexual activities with other women are known existing in all societies around the globe. However, the understanding of the size, trends and implications of female same sex behaviors and practices is generally lacking and vary within and among many countries including Tanzania. As a result, there is limited understanding of the public health importance of this group, which is often cited as the reason for not investing in work targeted at women who have sex with women and other minority groups in the country. It is from this perspective, that we conducted a formative qualitative study that aimed at, among other objectives, to establish the existence of women who have sex with women and the magnitude of female same sex behaviors and practices in Tanzania using a case study of the Dar-es-Salaam administrative region. Our findings prove that women who have sex with women exist mainly in urban areas in the country and for several reasons, their number is perceived rapidly increasing. We recommend further multidisciplinary (public health) research among women who have sex with women in the country to facilitate the availability of comprehensive and informative data on this population group.</p> Switbert R. Kamazima Happiness P. Saronga Jackline V. Mbishi Saidah M. Bakar Saumu K. Shabani Beatrice R. Stanslaus Copyright (c) 2021 Switbert R. Kamazima, Happiness P. Saronga, Jackline V. Mbishi, Saidah M. Bakar, Saumu K. Shabani, Beatrice R. Stanslaus 2021-03-31 2021-03-31 3 2 87 92 10.24018/ejmed.2021.3.2.750 Safety and Efficacy of Bivalirudin in Diabetic Acute Coronary Syndrome (ACS) Patients Undergoing Percutaneous Coronary Intervention (PCI) <p><em>Objective:</em> To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a tertiary care cardiac hospital.</p> <p><em>Background</em>: Prevention of hemorrhagic complications has emerged as a priority in patients undergoing PCI in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic ACS patients as DM itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI. Whether Bivalirudin is safe and effective in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown.</p> <p><em>Methods</em>: 218 diabetic ACS patients (age&gt;18 years and ≤ 75 years) who underwent PCI from May 2018 to April 2019 at UCC, BSMMU, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70-100 U/kg (targeted activated clotting time, ACT: 200-250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600&nbsp;mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke].</p> <p><em>Results</em>: Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between the groups (p&gt;0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). No other adverse effects were found significantly different between groups in 30 days of PCI.</p> <p><em>Conclusion</em>: In this small scale, prospective, randomized controlled study of diabetic ACS patients undergoing PCI in a single center showed that Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin.</p> A.B.M Golam Mostofa Tanjima Parvin Mohammad Rayhan Masum Mandal Rawnak Afrin Syed Ali Ahsan Copyright (c) 2021 A.B.M Golam Mostofa, Tanjima Parvin, Mohammad Rayhan Masum Mandal, Rawnak Afrin, Syed Ali Ahsan 2021-04-02 2021-04-02 3 2 93 97 10.24018/ejmed.2021.3.2.768 Effects of Baby Massage in Reducing Body Temperature after Combined Diptheri Pertussis Tetanus/Hepatitis B Immunization <p><em>Background</em>: Side effects that may often occur after immunization include fever in infants after to combined Diptheri Pertusis Tetanus/Hepatitis B (DPT/HB) vaccine. Fever in infants or toddlers is a case that cannot be ignored because it can interfere with the comfort and development of infants and toddlers.</p> <p><em>Objectives</em>: This research aims to analyze the effects of baby massage in lowering body temperature among babies given combined DPT/HB immunization.</p> <p><em>Material and Methods</em>: It is a quasi-experiment using one intervention group. The population and sample are babies aged 2-5 months visiting the Work Area of Puskesmas Lombok Barat in Indonesia that meet inclusion criteria. Baby massage was administered in the morning and in the afternoon for 5 days, with the first 2 days prior to combined DPT/HB immunization 1, the second 1 day at the time of immunization, and the last 2 days after immunization. The same treatment was also carried out for combined DPT/HB immunization 2. Prior and after massage, baby temperatures were measured at the axila using a digital thermometer, with the results put in an observation sheet (graph). Body temperature measurement was observed for 2 months. Data gathered were then tested using non-parametric test (Wilcoxon).</p> <p><em>Results:</em> there is reduction in body temperature among babies given combined DPT/HB immunization 1 and combined DPT/HB immunization 2. Babies given combined DPT/HB immunization 1 had average body temperature of 0,2±0.18 °C in the morning and 0,21±0.25 °C in the afternoon. Meanwhile, babies given combined DPT/HB immunization 2 had average body temperature of 0,26±0.19 °C in the morning and 0,2±0.23&nbsp;°C in the afternoon. Effect of massage in reducing body temperature among babies given combined DPT/HB immunization 1 is at (p&lt;0.005) and at (p&lt;0.005) for combined DPT/HB immunization 2.</p> <p><em>Conclusion:</em> massage can be performed before or after babies are immunized with combined DPT/HB to lower their body temperature.</p> Linda Meliati Ni Putu Karunia Ekayani . Suwanti Copyright (c) 2021 Linda Meliati, Ni Putu Karunia Ekayani, . Suwanti 2021-04-05 2021-04-05 3 2 98 102 10.24018/ejmed.2021.3.2.753 Neuropsychological Correlates and Frequency of Tinnitus in Patients Injured in Motor Vehicle Accidents <p><em>Background:</em> There is a lack of data on the frequency and neuropsychological correlates of tinnitus in distinct clinical populations such as persons injured in high impact motor vehicle accidents (MVAs).</p> <p><em>Method:</em> Tinnitus severity and frequency were analyzed statistically in de-identified data of 106 post-MVA patients (mean age=39.5, SD=13.1; 31 males and 75 females). Correlations of tinnitus to the patients’ scores on the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Brief Pain Inventory, Insomnia Severity Index, PTSD measure (PCL-5), and to ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire were evaluated. The patients were interviewed an average of 53.6weeks (SD=39.9) after their MVA; all continued to suffer from post-MVA symptoms requiring therapy.</p> <p><em>Results:</em> Tinnitus was reported by 70 of the 106 post-MVA patients (66%). Slightly less than a half of the 70 rated their tinnitus as “frequent” or “persistent” and slightly more than a half as “occasional.”</p> <p>With respect to Rivermead and SNPSS items, the severity and frequency of tinnitus correlated significantly (at p&lt;.01, 2-tailed) with oversensitivity to light, restlessness, word finding difficulty, hand tremor, stutter, and instances of reduced muscular control over hand or arm (rs ranging from .28 to .37). Tinnitus severity correlated also with tingling in the limbs (r=.31), and with impaired balance (r=.28). Tinnitus frequency correlated also with difficulty articulating words (r=.28). Tinnitus also significantly correlated with ratings of pain and of insomnia (rs ranging from .26 to .32), but not with variables such as PTSD, depression, or anxiety.</p> <p><em>Discussion and Conclusions:</em> Tinnitus is correlated with some aspects of whiplash trauma and the post-concussion syndrome. However, the size of these relationships is rather weak.</p> Zack Z. Cernovsky Stephan C. Mann Varadaraj R. Velamoor Copyright (c) 2021 Zack Z. Cernovsky, Stephan C. Mann, Varadaraj R. Velamoor 2021-04-05 2021-04-05 3 2 103 106 10.24018/ejmed.2021.3.2.771 Removal of Silicon Oil from the Vitreous Cavity via the Anterior Chamber. Eight Years of the Author’s Experiences <p><em>Purpose: </em>To evaluate usefulness and safety of removal of silicone oil from the vitreous cavity via the anterior chamber.</p> <p><em>Methods:</em> The procedures were performed between 2012 and 2020 in 31 patients who required endotamponade with the use of light silicone oils. In most of the patients, the procedure was combined with cataract removal, secondary lens implantation or transscleral fixation of an artificial lens. A passive bimanual technique was used to replace silicone oil with fluid.</p> <p><em>Results:</em> The procedure to remove silicon oil via the anterior chamber proceeded without serious intra- and postoperative complications. There were no hypotony observed in first postoperative day.</p> <p><em>Conclusion:</em> Patients eligible for the procedure are those who have preoperative indications for silicone oil removal and whose removal path via the anterior chamber is not associated with a special need to remove the lens from the eye.</p> Adam Cywinski Copyright (c) 2021 Adam Cywinski 2021-04-06 2021-04-06 3 2 107 110 10.24018/ejmed.2021.3.2.774 Influence of Having Breakfast on Happiness and Attention-Concentration among High School Students <p><em>Background:</em> Healthful nutrition has a positive connection with both physical and mental health. Breakfast is often considered as the most important meal of the day. Despite the benefits, skipping the morning meal is highly prevalent among adolescents. Healthy eating has an effect on happiness and concentration but a firm connection has not been established. Breakfast skipping can be a factor and a gap in the literature exists in this regard. The aim of this study was to evaluate the relationships between eating breakfast, happiness and attention concentration among high school students.</p> <p><em>Methods:</em> In this descriptive cross-sectional study, a convenient sampling strategy was used to select the students from an International school located in Riyadh, Saudi Arabia. The 29-item Oxford Happiness Questionnaire along with demographic variables was employed as research instrument. Chi-square test, student t-test and ANOVA were used to compare different categorical variables.</p> <p><em>Results:</em> The overall Happiness mean score was 3.621 ± 0.6637. Students who were regular at having breakfast every day had higher happiness mean scores. Overall, 40% of the participants reported to have decreased concentration/attentiveness during the first 4 lectures at school. Majority (55%) of the breakfast skippers were distracted in the lessons. A regular breakfast eating habit was found to be significantly associated with happiness (p=0.04) and concentration during lectures (p=0.04) respectively. Majority of the students had insufficient physical activity (72%) and had experienced stress (88%) in the last six months respectively. The prevalence of being overweight/ obese among breakfast skippers was higher (39%) than was in breakfast consumers (26%).</p> <p><em>Conclusion:</em> Eating breakfast was associated with higher happiness scores and better concentration among high school students. An alarmingly high prevalence of stress among students is a cause of concern. Schools should start breakfast eating programs and promote physical activity to reduce stress. Future studies are needed to explore the factors associated with stress.</p> S. Marriyah Irfan S. Fatima Irfan Copyright (c) 2021 S. Fatima Irfan 2021-04-07 2021-04-07 3 2 111 116 10.24018/ejmed.2021.3.2.775 The Association between Hba1c- Derived Estimated Average Glucose (Eag) with Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in Patients with Type 2 Diabetes in A Cohort of Patients in a Tertiary Care Hospital in Sri Lanka <p><em>Introduction:</em> Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to insulin or poor production. FBS, PPBS and Glycated Haemoglobin (HbA1c) are the major tests that are used to monitor chronic glycemia worldwide. HbA1c level remains the gold standard test for assessment of glycemic control at follow up and it reflects the mean glucose values in the previous three - month period. HbA1c is expressed as a percentage, whereas the day-to-day monitoring and treatment of diabetes are based on blood glucose levels expressed as milligrams per deciliter (mg/dl) or millimoles per liter (mmol/L). Due to the difference in the denominators of FBS/PPBS with HbA1c, it causes confusion to the patients regards their glycaemic control. “Estimated average glucose” or eAG derived from HbA1c has been promoted by the American Diabetes Association (ADA). American Association of Clinical Chemists concludes that the correlation (r =0.92) is strong enough to justify reporting both HbA1c and eAG which indicate the 3- month control of the average sugar of the patient. This is easy for the patient as both FBS/PPBS and eAG are expressed with the same denominator for daily glucose checks and long-term control respectively, enhancing the glycaemic control.</p> <p><em>Objectives:</em> To determine the statistical correlation between eAG derived from HBA1C using the Nathan’s regression equation with FBS and PPBS in patients with T2DM. To analyze the significance of eAG as opposed to HbA1C as a marker of long-term glycemic control in T2DM.</p> <p><em>Methodology:</em> A retrospective analytical study done at the Department of Haematology of the Sri Jayewardenepura General Hospital, Sri Lanka. A simple random sampling technique was used, over a period of one year commencing June 2019 to June 2020, to obtain the laboratory records through laboratory information system of 201 adult patients both males and females who were diagnosed with T2DM. HbA1c, FBS, PPBS done on the same day were recorded. The eAG(mg/dl) was calculated using the Nathan’s regression equation (eAG = 28.7 x HbA1c – 46.7). Three groups were generated according to the patients’ levels of FBS and PPBS.</p> <p><em>Statistical Analysis:</em> Data were double entered and analyzed using (SPSS) version 20. Descriptive statistical methods were used to calculate the median, mean standard deviation of age, HBA1c, FBS, and PPBS. Correlations between study variables were done with Pearson’s correlation method. The p value, lower than 0.05 was considered as statistically significant. Coefficient of determination (R Sq) was used to a statistical measure of how close the data are to the fitted regression line.</p> <p><em>Results:</em> The total population of patients in both the FBS and PPBS groups showed a significant statistical correlation with eAG. The individual subgroups did not conform to this correlation. The results reveal no statistical correlation in both FBS and PPBS with eAG in patients with good glycaemic control. There was a significant statistical correlation in both FBS and PPBS with eAG in the groups of patients with moderately poor control. In those with markedly poor control the FBS did not show a statistical correlation with eAG, as opposed to the PPBS.</p> <p><em>Conclusion:</em> The clinical importance of HbA1C/eAG in diagnosis and management of T2DM can be re-emphasized by this study. HbA1C along with eAG may be added as a test in the management of T2DM, for the better understanding and maintenance of good glycemic control. As eAG values, derived by the Nathan’s regression equation in our study scattered very close to the regression line, it provided a more complete and representative measure of average glucose in past 3 months. We conclude that HbA1c values were reliably translated into eAG measurements which would be easily understood by the patients being of the same denominator as the FBS/PPBS.</p> C. C. Kariyawasan B. L. T. Balasuriya S. A. C. D. Ranatunga D. M. C. Dissanayake S. R. G. P. Herath Copyright (c) 2021 C. C. Kariyawasan, B. L. T. Balasuriya, S. A. C. D. Ranatunga, D. M. C. Dissanayake, S. R. G. P. Herath 2021-04-08 2021-04-08 3 2 117 121 10.24018/ejmed.2021.3.2.761 Pantaloon Hernia in a Female: A Rare Finding <p>The incidence of inguinal hernia in females is less compared to the males. Pantaloon hernia in females is even rarer and may be first diagnosed during surgery. We report a rare case of pantaloon hernia in a 60 year old female patient. She presented with reducible left groin swelling of 3 years duration and a clinical diagnosis of an indirect inguinal hernia made. A direct sac and an indirect sac were discovered at operation on both sides of the inferior epigastric artery. The posterior wall was repaired by Lichtenstein method. Patient made an uneventful recovery and there was no recurrence after 12 months of follow up. Though pantaloon hernia is rare in females, proper dissection, and identification of structure in the inguinal canal is necessary to make the correct diagnosis and to offer the appropriate treatment.</p> Onyeyirichi Otuu Uche Emmanuel Eni Callistus Ugochukwu Ndunaka Nwanneka Louisa Kwentoh Copyright (c) 2021 Onyeyirichi Otuu, Uche Emmanuel Eni, Callistus Ugochukwu Ndunaka, Nwanneka Louisa Kwentoh 2021-03-12 2021-03-12 3 2 1 2 10.24018/ejmed.2021.3.2.727 Incisional Hernia Post Open Appendectomy: A Case Report <p>Incisional hernia is an unusual postoperative complication after appendectomy through a McBurney’s incision with an incidence of less than one percent. We present a case of incisional hernia post open appendectomy in a 40-year old woman. She presented to us with a painless right lower abdominal swelling that developed after an emergency open appendectomy for perforated appendix 7 years earlier. She was clinically stable with BMI of 24.5 kg/m<sup>2</sup>. She had a non-tender, reducible mass of 20×16×8 cm protruding through a healed right iliac fossa transverse scar. She had an open onlay mesh repair with satisfactory outcome. Post appendectomy incisional hernia is uncommon. Hernioplasty offers a satisfactory outcome.</p> Onyeyirichi Otuu Ugochukwu Uzodimma Nnadozie Copyright (c) 2021 Onyeyirichi Otuu, Ugochukwu Uzodimma Nnadozie 2021-03-12 2021-03-12 3 2 3 5 10.24018/ejmed.2021.3.2.728 Papillary Thyroid Carcinoma Occurring in Branchial Cleft Cyst: Case Report and Review of Literature <p>Ectopic thyroid tissue is ubiquitous in the body, most frequently seen at the base of tongue, accounting for approximately 95% of reported cases. Branchial cleft cyst, a congenital abnormality, can occasionally harbor thyroid tissue inside the cyst. These ectopic thyroid tissues can develop the same disease as the orthodox thyroid gland, including the malignant diseases. Papillary thyroid carcinoma arising in the branchial cleft cyst was extremely rare, total of only 14 cases were reported in the literature. Herein, I report additional case which was discovered incidentally after surgery.</p> Swei H. Tsung Copyright (c) 2021 Swei H. Tsung 2021-03-16 2021-03-16 3 2 6 8 10.24018/ejmed.2021.3.2.734 Do Brown Marmorated Stink Bug Eggs Can Be a Factor of Vulvovaginal Inflammation? Clinical Case <p><em>Background:</em> Biologists explain the dominance of stinky bugs (Halyomorpha halys) in Europe, Russia, and Ukraine in the summer of 2019 and 2020 with an abnormally hot summer.</p> <p><em>Clinical case:</em> During gynecological examination of 29 years old woman in the outpatient department with complaints of discomfort on the external genitalia were revealed more than 20 white foreign bodies. In 3 days, a white bug (Halyomorpha halys) was identified from white foreign bodies.</p> V. O. Sklyarova N. V. Bitchenko R. A. Chajkivskyj V. G. Kozytska P. O. Sklyarov Copyright (c) 2021 V. O. Sklyarova, N. V. Bitchenko, R. A. Chajkivskyj, V. G. Kozytska, P. O. Sklyarov 2021-03-24 2021-03-24 3 2 9 11 10.24018/ejmed.2021.3.2.748 Conservative Management of Isolated Proximal Traumatic Pancreatic Injury: A Case Report <p><em>Background</em>: Blunt traumatic pancreatic injuries are rare conditions in case of motor vehicle collision (MVC) and isolated injuries even rarer. Surgical approach is usually preferred in case of advanced pancreatic injuries. In this study we try to shed the light on the role of completely conservative approach in the management of a proximal pancreatic injury.&nbsp;</p> <p><em>Case Summary</em>: A 19-year-old male patient presented to the ER three days following MVC with upper abdominal pain. Abdominal US showed free intraperitoneal fluids and laboratory results showed elevated total leukocyte count, serum amylase and lipase. CT showed transection at pancreatic head which was grade 5 with free intrabdominal fluids; hence isolated pancreatic injury was diagnosed. At that point, the patient was hemodynamically stable and conservative management was implemented. He was admitted in the ICU for three days followed by 28 days in the ward where patient condition was closely monitored on daily bases.&nbsp; Serial interval imaging showed spontaneous resolution of the intraperitoneal collection together with improvement of the injury, respectively. After completing his course, the patient was discharged and monitored as an outpatient.</p> <p><em>Conclusion</em>: Conservative treatment can be adopted in patients with proximal pancreatic injuries with complete duct disruption in otherwise hemodynamically stable patients.</p> Masoud Alsaifi Badriya Alaraimi Ahmed Alkindy Copyright (c) 2021 Masoud Alsaifi, Badriya Alaraimi, Ahmed Alkindy 2021-03-24 2021-03-24 3 2 12 15 10.24018/ejmed.2021.3.2.733 The Spontaneous Retropharyngeal Space Hematoma: How to Manage? <p><em>Introduction:</em> Spontaneous Retropharyngeal Hematoma (SRH) is a rare affection which occurs without traumatism.</p> <p><em>Case report:</em> A 68 years old woman brought to the emergency department with a cervico-thoracic swelling rapidly increasing in size without any previous traumatic history or anticoagulant medication. Complicated by dysphagia and dysphonia without signs of dyspnea. The clinical examination revealed a painful anterior cervico-thoracic swelling with an ecchymotic cupboard on it. Cervico-thoracic CT scan found a voluminous retro-pharyngeal collection, spontaneously hyperdense, extended to the oropharynx and antero-superior mediastinum without further lesions. Biological assessment was without abnormalities. The diagnosis of retropharyngeal hematoma was retained. The treatment was based on corticosteroids and antibiotics drugs with strict clinical and radiological monitoring. With conservative treatment, the evolution was favorable, marked by progressive regression of the hematoma until its disappearance and an absence of recurrence after a retreat of one year.</p> <p><em>Conclusion:</em> The clinical presentation of a retropharyngeal hematoma out of an evocative context is misleading and lead to radiological investigation without delaying the treatment which varies from supervision to surgery according to respiratory status and evolution under strict control.</p> Y. Lakhdar D. Berrada Elazizi M. Elbouderkaoui Y. Rochdi A. Raji Copyright (c) 2021 Y. Lakhdar, D. Berrada Elazizi, M. Elbouderkaoui, Y. Rochdi, A. Raji 2021-03-27 2021-03-27 3 2 16 18 10.24018/ejmed.2021.3.2.755 A Case Report on Genetic Analysis of Exon2 of Thyroid Transcription Factor 2 Gene in Congenital Hypothyroidism Patient <p>A-3-year- old Bangladeshi pediatric patient named Tasin was presented with a diagnosed case of congenital hypothyroidism (CH). This type of hypothyroidism may occur due to the alteration in the nucleotide sequences of the Thyroid transcription factor 2 gene. Few studies are present on the genetic basis of this disease. CH is common in Bangladesh, may be due to geographical variation or other causes. Therefore, this study was conducted to identify whether there was any genetic alteration in the exon2 of Thyroid transcription factor 2 gene.</p> <p>With due procedure and permission from the guardian of the pediatric patient, socio-demographic data was collected. Isolation of DNA, quantitation and qualitation of DNA was ensured, polymerase chain reaction (PCR) was performed, the amplicons that was obtained from PCR; validated visually by gel electrophoresis methods; cycle sequencing was performed by Sanger sequencing. The chromatogram data that was obtained from Sanger sequencing was analyzed and compared with the National Center for Biotechnology Information database by Basic&nbsp;Local&nbsp;Alignment&nbsp;Search&nbsp;Tool search. Sanger sequencing revealed substitution (c.1051G&gt;T) in the Sequence Tagged Site of the exon2 of Thyroid transcription factor 2 gene and this is new variants and not reported in National Center for Biotechnology Information database.</p> Marjia Khatun Laila Anjuman Banu Copyright (c) 2021 Marjia Khatun, Laila Anjuman Banu 2021-03-31 2021-03-31 3 2 19 21 10.24018/ejmed.2021.3.2.744 Rare Case Report of Primary Gastric Melanoma <p>Gastric melanomas are usually metastatic, and primary is almost rare entity.</p> <p>Present case is a rare malignant melanoma of the gastric region with barely reported cases in the literature. A 65 year old male presented with pain abdomen and melena He was evaluated with relevant investigation. UGI endoscopy and PETCT shows large polypoidal irregular gastric mass in the proximal curvature extending upto gastroesophageal junction. Endoscopic biopsy a ulcero-infiltrating tumour, Individual cells are large, round, having moderately pleomorphic, hyperchromatic nuclei with prominent eosinophilic nucleoli and moderate eosinophilic cytoplasm. Immunohistochemistry of S100 and HMB45 was positive and negative for CK7 and CK20.</p> <p>Early diagnosis of primary gastric melanoma allows for better prognosis of the patient from the right intervention.</p> K. T. Ashwini Deepa Mahesh M. S. Sandeep Copyright (c) 2021 K. T. Ashwini, Deepa Mahesh 2021-03-31 2021-03-31 3 2 22 24 10.24018/ejmed.2021.3.2.763 Retroperitoneal Hodgkin Lymphoma with Giant Renal Cyst: Case Report <p>Detection of Hodgkin’s lymphoma at earlier stages increases the chances of successful chemotherapy treatment. Retroperitoneal localization makes the diagnosis difficult, which can delay treatment. we report here the case of 65-year-old patient presenting right lumbar pain for 2 years, who was admitted for surgical exploration of a fluid retroperitoneal mass, after an inconclusive CT-guided biopsy and a surgical biopsy showing reactive lymph node tissue remodeled without tumor element. after operating the patient, the pre-cellar lymph node dissection concluded with classic Hodgkin lymphoma.</p> H. Lachhab H. Moudlige C. Waffar A. Moataz M. Dakir A. Debbagh R. Aboutaieb Copyright (c) 2021 H. Lachhab, H. Moudlige, C. Waffar, A. Moataz, M. Dakir, A. Debbagh, R. Aboutaieb 2021-03-31 2021-03-31 3 2 25 26 10.24018/ejmed.2021.3.2.764 Clinical Practice of Hepatorenal Syndrome: A Brief Review on Diagnosis and Management <p>The hepatorenal syndrome is one of various potential causes of acute kidney injury in patients with decompensated liver disease. Hepatorenal syndrome is diagnosed based on reducing kidney function without any evidence of intrinsic kidney disease, including proteinuria, hematuria, or abnormal kidney ultrasonography. Clinically, hepatorenal syndrome is divided into two types named type 1 and type 2. The most favorable therapy for HRS cases is liver transplantation; however, only a few undergo this procedure due to the high mortality. Other modalities for hepatorenal syndrome therapy are pharmacology and non-pharmacology approaches. The purpose of management HRS is to optimize and stabilize the patient until an organ transplant available. This review aims to discuss the underlying pathophysiology and demonstrate the diagnostic approach of hepatorenal syndrome to determine the most appropriate therapeutic measures in clinical practice. The clinicians must be aware of management principles of hepatorenal syndrome to improve the quality of care for patients and optimize the clinical conditions.</p> . Rendy . Febyan Krisnhaliani Wetarini Copyright (c) 2021 . Rendy, . Febyan, Krisnhaliani Wetarini 2021-03-23 2021-03-23 3 2 1 7 10.24018/ejmed.2021.3.2.743 Vitamin D Deficiency in the Elderly Patients and Role of Vitamin D in the Prevention of COVID-19 Infection <p>SARS Covid'19 is declared as a global pandemic by World Health Organization [1]. The aim of this short report is to find out the association of Vitamin D in prevention of Covid'19 in elderly patients who are already having other co-morbidities. People of any age are susceptible to Corona virus but the elderly patients and patients with chronic underlying diseases are at higher risk. Many elderly patients with COVID-19 are at risk of mal-nutrition [2].</p> <p>Vitamins are of two types, Lipid soluble vitamins and water-soluble vitamins [3]. Lipid soluble vitamins can be stored in the body while water soluble vitamins cannot be stored in the body, hence needed to take regularly [4]. Vitamin D is a lipid soluble vitamin also it can be synthesized by our own body.</p> Nauman Khan . Tahmina Copyright (c) 2021 Nauman Khan, . Tahmina 2021-03-31 2021-03-31 3 2 8 9 10.24018/ejmed.2021.3.2.765 Immune Responses to SARS CoV-2: A Scoping Review <p>COVID-19 is noxious and constitutes a raft of adverse multiplier effects. As such, there is urgent need to understand the disease well and take action to mitigate its punitive pathologic &amp; economic outcomes. Comprehending the conduct of the immune system during and after infection may provide fundamental leads to unraveling effective interventions. Some vaccines and drugs have since been validated and made available for emergency use among priority populations. However, these vaccines were developed at an accelerated pace and mainly on the basis of rudimentary immunological &amp; molecular events. Therefore, there is need for continuous revelation of precise and more elaborate hallmarks in order to improve on, or develop more efficacious and safe interventions. Three scientific databases (PubMed, Cochrane and EMBASE) were searched between 1st December, 2020 and 15th January, 2021 for information about immune responses to SARS COV-2. Studies that utilized experimental designs, exhibited little to no likelihood of bias, published in highly refereed and peer reviewed journals were selected. A total of 10 papers were shortlisted for the final synthesis. A set of cytokines including: IL-2, IL-6, IL-7, IL-10, TNF, and GM-CSF are recovered in most cases. However, IL-6 is featured in most severe and fatal events. There wasn’t congruency by different studies on the precise conduct of T-cells during infection. Some studies reported elevated levels of both CD+4 &amp; CD+8 T-cells among severe cases while others reported exhausted elevated levels of the same immunological parameters during mild disease. Higher levels of Natural Killer-cells (NK-cells) as well as Neutralizing Antibodies (Nabs) correlate with better disease outcomes. However, considering the role played by Abs in the production of cytokines (pro and anti-inflammatory), it may be crucial to profile the risk/benefit ratio of Abs during infection. Interventions that seek to: reverse high production of pro-inflammatory cytokines (IL-6), potentiate release and function of NK-cells, as well as Nabs and moderate exhaustion of CD+4 &amp; CD+8 T-cells, may constitute promising outcomes.</p> Michael Walekhwa Richard Kagia Margaret Muturi Copyright (c) 2021 Michael Walekhwa, Richard Kagia, Margaret Muturi 2021-04-01 2021-04-01 3 2 10 16 10.24018/ejmed.2021.3.2.766 New Insights on Diagnosis and Treatment of Cerebral Venous Thrombosis – A Narrative Review <p>Cerebral venous thrombosis (CVT), although accounting for only 0.5-1% of all strokes, remains a potentially fatal neurological emergency, which must be promptly diagnosed and treated. Consisting of two parts, this review aims to highlight the most important data from recent years regarding diagnosis and treatment of CVT, illustrating both the current modern therapeutic approach and the future research directions in the field. Regarding the clinical diagnosis, the neurologist may sometimes have difficulties in recognizing this pathology, given the diverse clinical picture of the acute stage of CVT that can mimic various neurological disorders. In addition, although most risk factors (procoagulation status, infections, trauma, systemic diseases) are known and can be easily detected, in a significant percentage of cases the etiology remains uncertain. For paraclinical diagnosis, among the imaging investigations essential to support the diagnosis, CT angiography and MRI venography are reliable alternatives to digital subtraction angiography which represent the gold standard nowadays. In terms of treatment, international guidelines provide general directions for anticoagulation, with low molecular weight heparin being highly recommended. Regarding invasive treatment methods (thrombolysis, thrombectomy) that could be used in severe cases where anticoagulation has been shown to be insufficient, as well as symptomatic therapy, the evidence is often insufficient, new randomized clinical trials with large cohorts of patients being required.</p> Thomas Gabriel Schreiner Copyright (c) 2021 Thomas Gabriel Schreiner 2021-04-06 2021-04-06 3 2 17 20 10.24018/ejmed.2021.3.2.772