European Journal of Medical and Health Sciences European Journal of Medical and Health Sciences European Open Access Publishing en-US European Journal of Medical and Health Sciences 2593-8339 A Narration: 20th v/s 21st Century: Pandemic v/s Another Pandemic: Virus v/s Another Virus (Spanish Flu V/S COVID-19) <p>Pandemic leads to major mortality and morbidity. Many pandemics occur over the centuries, but the mother of all pandemic was "Spanish Flu" and nowadays we are facing another huge uncontrollable "Covid 19" pandemic of the current century. The purpose of this comparative review is to help and provide guidance for frontline medical staff in dealing with this current outbreak to differentiate and seek information with the previous pandemic and get knowledgeable guidance for future dealings of COVID-19. Peer-reviewed literature on the outbreaks of infectious disease has steadily increased in recent years, but the major pandemics should be compared to find out the similarities and differences. To do so, we provide step by step contents of both diseases.</p> A. Saulat A. N. Jafri Copyright (c) 2021 A. Saulat, A. N. Jafri 2021-01-08 2021-01-08 3 1 1 8 10.24018/ejmed.2021.3.1.594 Post-Stroke Quality of Life Outcomes After Instituting New Stroke Care Quality Indicators <p><em>Background</em>: In 2013 the Israel Ministry of Health identified the care and treatment of acute cerebral ischemic stroke as failing to achieve expected standards. The Ministry decided to raise standards by defining and instituting, nationwide, a battery of linked care quality indicators to be applied across all relevant facilities and contexts. Five indicators were selected for five key junctures in the AIS care process.</p> <p><em>Methods</em>: This paper presents and analyses the effects of the implementation of these new care quality indicators on the post-discharge quality of life outcomes of Israeli stroke sufferers. The patient sample comprises patients from Israel’s Central region, where stroke care provision and access is relatively high, and from the peripheral North region, where provision and access are limited.</p> <p><em>Results</em>: Those who were not treated with thrombolytic treatment and/or cerebral blood vessel catheterization, those who suffered severer strokes, women, the older age groups, non-Jews and North region residents display significantly worse physical functioning outcomes and worse quality of life outcomes on all indicators.</p> <p><em>Conclusions</em>: Stroke care access and provision disparities translate into significantly higher rates of post-discharge disability, impaired physical and social functioning, and a lower quality of life.</p> <p>The effectiveness of healthcare improvement by the deployment of care indicators is closely associated with the lifestyle, socio-demographic and socioeconomic status of different population groups. The effective implementation of quality care indicators also relies heavily on closing the access and provision gaps between the populations living in central and peripheral areas. Two obvious directions for action are to expand and improve the rehabilitation care network and to combat the age discrimination in hospital stroke treatment.</p> Khaled Awawdi Carmel Armon Itzhak Kimiagar Mahdi Tarabeih Riad Abu Rakia Copyright (c) 2021 Khaled Awawdi, Carmel Armon, Itzhak Kimiagar, Mahdi Tarabeih, Riad Abu Rakia 2021-01-08 2021-01-08 3 1 9 15 10.24018/ejmed.2021.3.1.641 Role of Growth Factors-rich Plasma (Activated Platelet-rich Plasma) in Androgenic Alopecia: Literature Review and Suggested Treatment Protocol <p>Androgenetic alopecia (AGA) has become a prevalent hair fall dysfunction due to genetic as well as hormonal effects distinguished by androgen-related gradual weakening of the scalp hair with a sequence. Around turn 60, 45 percent of males and 35 percent of females come down with AGA. Owing to the small number of successful AGA therapies, Platelet-rich Plasma (PRP) has been an attractive alternative therapeutic approach. Platelet-rich plasma (PRP) is being proposed for the incorporation of greater levels of growth factors and certain other biologically active substances in wounded lesions to achieve the specific healing objectives. PRP is already being included in dentistry and cosmetic surgery for about four decades. Even the usefulness of this autologous substance in both these fields seems to be well known. Notably, in treating different cosmetic procedures, PRP is already progressively seen because its high constituents of platelet-derived growth factors and cytokines may improve the biochemical mechanisms correlated with tissue repair and regeneration. After activation, platelets within the PRP secrete various growth factors that exhibit the results of hair regeneration. However, PRP may be prepared with different protocols and procedures. Differences could influence the character and possible effectiveness of the end PRP product in the availability of RBCs and WBCs, the introduction of thrombin or calcium chloride to trigger fibrin initiation, and pH-altering substances. A standard procedure for PRP preparation and application and a framework to assess results have not been developed, though many research works have been published. Thereby, the subsequent research article presents a proposed treatment protocol for AGA by platelets-rich plasma (PRP), which has been confirmed after reviewing different studies performed by researchers that exhibit PRP's efficacy in AGA.</p> Sheher Bano Tariq Mehmood Dar Copyright (c) 2021 Sheher Bano, Tariq Mehmood Dar 2021-01-08 2021-01-08 3 1 16 23 10.24018/ejmed.2021.3.1.629 A Rare Case of Burkholderia Pseudomallie Presenting as Brain Abscess <p><em>Rationale:</em> Meiliodosis is an extremely rare condition in Neurosurgery which is caused by the gram negative organism Burkholderia pseudomallie. Burkholderia pseudomallei (also known as Pseudomonas pseudomallei) is a Gram-negative, bipolar, aerobic, motile rod-shaped bacterium. It is a soil-dwelling bacterium endemic in tropical and subtropical regions worldwide, particularly in Thailand and northern Australia. It infects humans and animals and causes the disease melioidosis. It is also capable of infecting plants. If treatment is below par or delayed, this infection can produce diverse clinical symptoms and result in death.</p> <p><em>Patient Concerns:</em> A 52 year old female, known case of Type 2 Diabetes mellitus on insulin, presented with complaints of a swelling in the left parieto-occipital region since 2 months &amp; headache since 1 month. She had a past history of a fall from scooter 7 months ago, which then was not radiologically imaged. Patient was, otherwise, conscious, oriented and had no focal neurological deficit.</p> <p><em>Diagnosis:</em> left parieto-occipital space occupying lesion confirmed by Ct brain and [mri + mrv] brain and culture and sensitivity of fluid aspirate showed moderate growth of burkholderia pseudomallie.</p> <p><em>Interventions:</em> Intravenous Ceftazidime [1 g/12 h] was administered in-hospital for 4 weeks (Intensive Phase) and Oral Cotrimoxazole (Trimethoprim + sulfomethoxazole) {TAB.BACTRIM DS} twice daily was administered out-hospital (Maintenance Phase).</p> <p>Patient underwent Left parieto-occipital abscess drainage and debridement [Pus sent for Culture and Sensitivity] – Abscess drainage and removal of irregular thinned out bone around the skull defect + Biopsies sent from small extradural collection near the skull defect.Intravenous Ceftazidime was continued and discharged with Oral Cotrimoxazole (Trimethoprim + sulfomethoxazole).</p> Allen S. Sibil Suresh S. Kumar Alex Aiswariya Copyright (c) 2021 Allen S. Sibil, Suresh S. Kumar, Alex Aiswariya 2021-01-11 2021-01-11 3 1 24 27 10.24018/ejmed.2021.3.1.620 Wash Practices in Schools, Cameroon <p>This study investigated the influence of Water, Sanitation and Hygiene (WaSH) management on the bacteriological quality of students’ palms in some schools within the Bamenda municipality, to serve as baseline data for strengthening of hygiene management and health policies in schools. The study employed a descriptive cross-sectional approach with data generated through questionnaires, swabbing of the palms of selected students and doorknobs, as well as culturing of the swabs for microbial identification. SPSS version 16.0 was used for data analysis and Chi-square test to determine significant differences in the level of bacteria on the palms of participants by gender. None of the schools met WHO standards, and the gap between toilet usage and hand washing after defecation was very significant (p &lt; 0.0001). Bacteria isolated included: Staphylococcus spp (63%), Escherichia coli (31%), Enterobacter sp (10%), Bacillus sp (10%), and Coliforms (5%). Two Fungi species: Yeast (10%) and Moulds (3%) were also isolated. The content of the curriculum, teaching and assessment mechanism for the WaSH programme management in schools was found to be in need of greater attention, schools and local governments focus on it being below expectation.</p> Mercy A. Manjong-Kofete Kenneth A. Yongabi Wilfred F. Mbacham Copyright (c) 2021 Mercy A. Manjong-Kofete, Kenneth A. Yongabi, Wilfred F. Mbacham 2021-01-13 2021-01-13 3 1 28 36 10.24018/ejmed.2021.3.1.625 Effect of Vitamin D on Elastin and Collagen Expression: In Vitro Study of Pelvic Organ Prolapse Prevention <p><em>Introduction</em>: Pelvic organ prolapse is defined as abnormal protrusion of the pelvic organ beyond its normal anatomical site. It occurs due to the structural weakness of the connective tissue that plays a role in supporting the uterus on the pelvic floor, specifically elastin and collagen. Our study evaluated the effect of vitamin D [1,25(OH)<sub>2</sub>D<sub>3</sub>] in preventing pelvic organ prolapse by aggregating elastin and collagen expression.</p> <p><em>Material and Methods</em>: A true experimental research was carried out by assessing the cell cultures of sacro-uterine ligament from female patients who underwent hysterectomy. The cell cultures were divided into groups that were exposed to vitamin D at different concentrations of 100 µM, 200 µM, 400 µM, 800 µM, and control without any exposure. The expression of elastin and collagen was subsequently analyzed using immunofluorescence and ELISA method.</p> <p><em>Results</em>: This study showed that exposure to vitamin D significantly affected elastin expression (<em>p</em>-value &lt;0.05). The concentration found to be the most effective to induce elastin expression is at 400 µM. Vitamin D also significantly affected the collagen expression (<em>p</em>-value &lt;0.05), with the concentration found to be the most effective to induce collagen expression is at 800 µM.</p> <p><em>Conclusion</em>: This study suggested that vitamin D had a significant positive effect of increasing extracellular matrix expression and potentially become a preventive agent for pelvic organ prolapse. Vitamin D is widely available in tropical countries like Indonesia, so this preparation is considered very easy for Indonesian women to apply.</p> . Rahajeng Tatit Nurseta Bambang Rahardjo Yahya Irwanto Daniel Alexander Suseno Copyright (c) 2021 . Rahajeng, Tatit Nurseta, Bambang Rahardjo, Yahya Irwanto, Daniel Alexander Suseno 2021-01-14 2021-01-14 3 1 37 41 10.24018/ejmed.2021.3.1.657 Relationship between Corrected QT Interval (QTc) Prolongation and Insulin Resistance in Obese Adult Male Subjects <p>QT Interval prolongation is common in insulin resistance state obesity. Insulin-induced hyperpolarization might be involved in ventricular repolarization leading to QTc lengthening. Therefore, this study is designated to investigate the relationship between corrected QT interval (QTc) prolongation and insulin resistance in obese adult male subjects. Apparently healthy adult male subjects (n=100) aged between 18-35 years residing in Magway Township were recruited by simple random sampling method. Then all the eligible subjects were categorized into 2 groups: non-obese [body mass index (BMI) 18.5 to 24.9 kg/m2, n= 40] and obese group [BMI ≥ 30.0 kg/m2, n=60] by their anthropometric parameters. Serum fasting glucose was measured by glucose oxidase method. Serum insulin level was determined by Enzyme-Linked Immunosorbent Assay (ELISA). Insulin sensitivity was calculated by Homeostatic Model Assessment (HOMA-IR). The QT interval was measured by routine 12-lead ECG and corrected QT interval (QTc) was calculated according to Bazett’s formula. In the present study, insulin sensitivity (HOMA-IR) was higher in obese subjects (4.64±2.3) than that of non-obese subjects (2.5±0.89) (p&lt; 0.001). There was significant positive correlation between QTc and HOMA-IR (r = 0.41, p&lt; 0.001, n = 100) in this study. HOMA-IR &gt;3.8 was considered as insulin resistance (IR) and QTc &gt; 440ms was regarded as QTc interval prolongation. Insulin resistance was significantly associated with prolonged QTc interval in the study population (X2=7.3, p&lt; 0.05, n=100). Risk of QTc interval prolongation was 3.4 times higher in subjects with IR (Odd ratio = 3.4; 95% confidence interval = 1.37 to 8.45). It was concluded that prolonged QTc interval is associated with insulin resistance state.</p> Zarchi Theint Theint Hlaing Soe Minn Htway Mya Thanda Sein Copyright (c) 2021 Zarchi Theint Theint Hlaing, Soe Minn Htway, Mya Thanda Sein 2021-01-14 2021-01-14 3 1 42 45 10.24018/ejmed.2021.3.1.655 The Second Wave of COVID-19 in Italy: What’s Going On? <p><em>Background:</em> a second wave (W2) of COVID-19 is affecting Italy.</p> <p><em>Objective:</em> to analyze the ratio between deaths and positive cases in two different 36-day periods of W2.</p> <p><em>Methods:</em> data were retrieved by the Official Bulletin of the Italian Protezione Civile. The analysis was based on mobile averages.</p> <p><em>Results:</em> The ratios deaths/positive cases in the first 35-day period form October 9th and November 13th were of 2.45 ± 0.482 and in the second 36-day period from November 14th and December 19th was 2.37 ± 0.416. There is no statistical difference between the periods (p&gt; 0.05). The differences are significant (p&lt;0.01) in terms of trends, since in the first period the curve is flat, while in the second is growing.</p> <p><em>Conclusions:</em> the reason of the different trends are several, such as the starting of the colder season, the delay in providing with the common flu vaccination. the confusion about the initiative of lockdown, and the poor care for the older people.</p> Umberto Cornelli Giovanni Belcaro Maria Rosaria Cesarone Martino Recchia Roberto Cotellese Copyright (c) 2021 Umberto Cornelli, Giovanni Belcaro, Maria Rosaria Cesarone, Martino Recchia, Roberto Cotellese 2021-01-14 2021-01-14 3 1 46 49 10.24018/ejmed.2021.3.1.638 Knowledge, Attitudes, and Practices towards COVID-19 of Pregnant Women at a Primary Health Care Facility in South Africa <p>COVID-19 pandemic has resulted in the death of hundreds of thousands of people globally. Several preventive measures have been recommended to reduce the spread of the disease. However, the level of knowledge, attitudes, and practices (KAP) of these preventive measures among pregnant women, are yet to be evaluated in South Africa. Therefore, the objective of this study was to determine the KAP towards COVID-19 among pregnant women. The purpose was to identify KAP gaps of pregnant women and develop educational materials and implement programmes. A questionnaire-based cross-sectional study was undertaken. Student’s t-test, ANOVA test, Pearson’s correlation test and Binary logistic regression analysis was carried out. Majority of the respondents were single (71%), unemployed (52%), and had low education (78% had either no or less than 12 years education). More than half (51.2%) had vulnerable comorbidities for COVID-19 infection and complication. Both knowledge and attitude mean of pregnant women were found to be low at 43.5% and 30% respectively. However, their practice on prevention of COVID-19 was good at 76%. Knowledge was found to be significantly positively correlated with practice towards COVID-19 (r= 0.111). Women having good knowledge were seven times more likely to practice positively regarding COVID-19 (P=0.019). Women having 1-5 years of education were 94% less likely to practice good towards COVID-19 prevention (P=0.018) compared to those having post matric education. The pregnant women in this research had inadequate knowledge and attitude of COVID-19 infection. However, preventive practices were good among them. Mass education and communication strategies are thus required to improve the knowledge and attitudes of pregnant women towards COVID-19.</p> A. M. Hoque A. M. Alam M. Hoque M. E. Hoque G. Van Hal Copyright (c) 2021 A. M. Hoque, A. M. Alam, M. Hoque, M. E. Hoque, G. Van Hal 2021-01-15 2021-01-15 3 1 50 55 10.24018/ejmed.2021.3.1.654 Validity of Steiner’s Automobile Anxiety Inventory <p><em>Background:</em> Steiner’s Automobile Anxiety Inventory (AAI) is a 23 item questionnaire which provides a quantitative measure of vehicular anxiety (amaxophobia), common in survivors of motor vehicle accidents (MVAs). The present study examines criterion and convergent validity of the AAI.</p> <p><em>Method:</em> De-identified data from a sample of 50 patients (mean age=39.1, SD=12.1; 17 men, 33 women) injured in high impact MVAs included the scores on Steiner’s AAI, as well as the pain ratings on the Brief Pain Inventory (BPI), scores on the Insomnia Severity Index (ISI), the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whetstone Vehicle Anxiety Questionnaire, and on Driving Anxiety Questionnaire (DAQ). The patients’ scores were compared to de-identified AAI data of 22 normal controls (mean age=45.9, SD=21.3; 10 men, 12 women).</p> <p><em>Results:</em> Mean score of the patients on Steiner’s AAI (mean=15.0, SD=2.5) was significantly higher than the one of normal controls (mean=3.2, SD=3.8) in a t-test (t=15.6, df=70, p&lt;.001). The underlying correlation is very high (r=.88): this indicates an excellent criterion validity. Satisfactory convergent validity is suggested by significant correlations (p&lt;.001) of Steiner’s AAI scores to the Whetstone Vehicle Anxiety Questionnaire (r=.58) and Driving Anxiety Questionnaire (r=.52). The AAI correlated at p&lt;.001 with post-accident neuropsychological impairments as measured by Rivermead (r=.89) and SNPSS (r=.72). Internal consistency of the AAI is satisfactory (Cronbach alpha=.95).</p> <p>Discussion and Conclusion: The results indicate satisfactory criterion and convergent validity of the Automobile Anxiety Inventory.</p> Zack Z. Cernovsky Milad Fattahi Larry C. Litman Silvia Tenenbaum Beta Leung Vitalina Nosonova Crystal Zhao Manfred Dreer Copyright (c) 2021 Zack Z. Cernovsky, Milad Fattahi, Larry C. Litman, Silvia Tenenbaum, Beta Leung, Vitalina Nosonova, Crystal Zhao, Manfred Dreer 2021-01-15 2021-01-15 3 1 56 61 10.24018/ejmed.2021.3.1.661 Serum Cotinine, Serum F2-isoprostane and Risk of Metabolic Syndrome in Adult Male Tobacco Users <p>Data on risk of metabolic syndrome among various forms of tobacco consumption in Myanmar tobacco users are currently limited. The present study aimed to determine and compare nicotine metabolites serum cotinine, oxidative stress marker serum F2-isoprostane in adult male tobacco users, and to find out relationships between these parameters and risk of metabolic syndrome. This cross-sectional study was done in 30 to 45 years old males: 84 cigarette smokers, 84 cheroot smokers and 84 betel quid with tobacco chewers. Metabolic syndrome was defined by National Cholesterol Education Program Adult Treatment Panel III definition. Serum cotinine concentration of cigarette smokers was significantly higher than that of cheroot smokers (p=0.026), however, no significant difference was seen between cigarette smokers and betel quid with tobacco chewers (p=1.000), and between cheroot smokers and betel quid with tobacco chewers (p=0.248). Serum F2-isoprostane concentration was significantly higher (p=0.001) in cigarette smokers than cheroot smokers and betel quid with tobacco chewers, but no significant difference was observed between cheroot smokers and betel quid with tobacco chewers (p=1.000). Compared with betel quid with tobacco chewers, cigarette smokers had 5.2 times (95% CI, 2.3-11.4) (p&lt;0.001) and cheroot smokers had 1.4 times (95% CI, 0.62-3.3) (p=0.402) higher risk of having metabolic syndrome. There was a significant association between the presence of metabolic syndrome and high serum cotinine as well as high serum F2-isoprostane. A significant correlation between serum cotinine and serum F2-isoprostane was found in betel quid with tobacco chewers, but not in cigarette smokers and cheroot smokers. The present study showed that both nicotine and oxidative stress take part in the pathogenesis of metabolic syndrome. Cigarette smoking has the highest risk of having metabolic syndrome, however, cheroot smoking as well as betel quid with tobacco chewing is related to metabolic syndrome as well.</p> Haymar Soe Win Win Yu Aung Ohn Mar Copyright (c) 2021 Haymar Soe Win, Win Yu Aung, Ohn Mar 2021-01-15 2021-01-15 3 1 62 67 10.24018/ejmed.2021.3.1.604 Elective Repair of Adult Abdominal Wall Hernia: A Nigerian Tertiary Hospital Experience <p><em>Background:</em> Hernia repair is one of the most common procedures performed by general surgeons, mostly in an elective setting. The true incidence/prevalence of hernias in Nigeria is unknown, however, suture (tissue) repair is predominantly reported.</p> <p><em>Aims:</em> To study the distribution of adult abdominal wall hernia and the surgical and anaesthetic techniques for elective repair in a Nigerian tertiary hospital.</p> <p><em>Methods: </em>A retrospective cross-sectional study of surgical patients undergoing elective abdominal wall hernia repair in University of Port Harcourt Teaching Hospital Nigeria from January 2009 to December 2014. Data extracted from the theatre records were patients’ demographic, type of hernia, repair technique, anaesthesia, operating time, and cadre of performing surgeon. Statistical analysis was performed using SPSS version 20.</p> <p><em>Results:</em> A total of 400 adult patients had elective repair of abdominal wall hernias during study period. The age range was from 17- 85 years (mean 39.3 ± 6.0) and M: F ratio of 1.9:1. There were 287(70.9%) inguinal, 43(10.6%) incisional and 36(8.9%) epigastric hernias. Mesh repair was recorded in 11(2.7%) cases with laparoscopic technique in 2 cases. Subarachnoid block was the choice anaesthesia in 365(85.4%) cases. The least mean operating time (38.6 mins) recorded was in repair of femoral hernia and longest (105.3mins) with incisional hernia repair.</p> <p><em>Conclusions: </em>Suture repair is the predominant repair technique. Routine hernioplasty and laparoscopic hernia repair need to be encouraged.</p> Emeka Ray-Offor Chidi Joshua Okeke Copyright (c) 2021 Emeka Ray-Offor, Chidi Joshua Okeke 2021-01-19 2021-01-19 3 1 68 72 10.24018/ejmed.2021.3.1.668 COVID-19 with Multiple Bacterial Co-infections: A Case Report <p>Coronavirus disease 2019 (COVID-19) is a contagious disease which was first identified in Wuhan, China in December 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for this ongoing pandemic worldwide. COVID-19 itself has a high mortality rate but in addition with bacterial co-infection, the risk of death amplifies much higher. The diagnosis of COVID-19 along with other respiratory co-infections can be a difficult task due to the similarities in their presentations. Here, we present a case of 60-years-old gentleman who was COVID-19 positive, co-infected with three types of bacterial pathogens, which were Mycobacterium tuberculosis, Enterobacter spp. and Pseudomonas. The patient was isolated and treated according to the pathogens’ culture sensitivity reports and was discharged when his condition improved and advised for routine follow-up. The source of the co-infection could not be identified and may have been hospital acquired. Therefore, every hospital should give utmost priority to infection prevention and control (IPC) strategies.</p> Sadia Saber Samia Rashna Ahmed Naz Yasmin Mohammed Tarek Alam Abdul Basit Ibne Momen Mohammad Monower Hossain Rafa Faaria Alam Copyright (c) 2021 Sadia Saber, Samia Rashna Ahmed, Naz Yasmin, Mohammed Tarek Alam, Abdul Basit Ibne Momen, Mohammad Monower Hossain, Rafa Faaria Alam 2021-01-07 2021-01-07 3 1 1 4 10.24018/ejmed.2021.3.1.646 Case Study of Using Ruqyah Complementary Therapy on a British Muslim Patient with Cluster Headache <p>A case study of a male British Muslim of Pakistani descend with severe cluster headache was presented. The patient only responded to morphine treatment but his condition continued to deteriorate. He resorted to <em>ruqyah</em> complementary therapy, which is based on incantations of the Quran, after seeking advice with a local imam (Islamic cleric). His condition improved significantly and continued to have weekly preventative <em>ruqyah</em> therapy. Since resorting to <em>ruqyah</em>, he has not any morphine treatment and the level and duration of pain have reduced significantly. <em>Ruqyah</em> is popular for the treatment of jinn possession but has also been found to have therapeutic effect on non-mental health problems. The case illustrates that complementing mainstream medicine with <em>ruqyah</em> can bring many benefits especially within the Muslim community. Cooperation between mainstream health service and faith healers is needed.</p> Hamidi Abdul Rahman Supyan Hussin Copyright (c) 2021 Hamidi Abdul Rahman, Supyan Hussin 2021-01-08 2021-01-08 3 1 5 7 10.24018/ejmed.2021.3.1.635 Atypical Presentation of Renal Cell Carcinoma: A Case Report <p>The most common form of malignant renal tumours is Renal cell carcinoma (RCC) which is considered for nearly 80-85% of primary renal tumors. Now a day renal tumours can usually be detected at primary stage due to the popularity of sonography. Clinical manifestations of RCC have a diverse range. Loin pain, hematuria and abdominal mass contemplate as a classical triad but only present in 4–17% of cases. Here, we present a unique case of RCC in a 65 years old elderly gentleman admitted to our hospital with upper gastrointestinal (GI) symptoms without any significant GI involvement.</p> Sadia Saber Paritosh Kumar Ghosh Mohammed Tarek Alam Naz Yasmin Mohammad Monower Hossain Rafa Faaria Alam Copyright (c) 2021 Sadia Saber, Paritosh Kumar Ghosh, Mohammed Tarek Alam, Naz Yasmin, Mohammad Monower Hossain, Rafa Faaria Alam 2021-01-13 2021-01-13 3 1 8 10 10.24018/ejmed.2021.3.1.650 Bardet Biedl Syndrome: A Rare Case Report in a Tertiary Care Teaching Hospital, Dhaka, Bangladesh <p>Bardet Biedl Syndrome (BBS) is an infrequent ciliopathic autosomal recessive genetic disorder that produces many effects and affects various body systems. Consanguineous marriage is conventionally considered as the most frequent etiology. The primary characteristics of the disorder are gradual visual impairment caused by retinal abnormalities, excessive weight gain, learning disabilities, Postaxial Polydactyly, Hypogonadism in males, renal abnormalities (kidney malformations and/or malfunctions). It affects both males and females. There is currently no specific cure for BBS but children with BBS benefit greatly from therapies like physical, occupational, speech and vision services. We, here, have presented a young boy of 15 years with the features of Bardet Biedl Syndrome.</p> Sadia Saber Mohammad Dabir Hossain Mohammed Tarek Alam Mohammad Monower Hossain Suhail Gulzar Copyright (c) 2021 Sadia Saber, Mohammad Dabir Hossain, Mohammed Tarek Alam, Mohammad Monower Hossain, Suhail Gulzar 2021-01-14 2021-01-14 3 1 11 14 10.24018/ejmed.2021.3.1.623 Atypical Chest Pain and Hypertension in a Young Woman <p>Hypertension among young people is fairly common, affecting one quarter of the global population and 1 in 8 adults aged between 20 and 40 years. It is one of the main modifiable risk factors for cardiovascular disease and mortality.</p> <p>Since many forms of secondary hypertension led to “treatment-resistant” hypertension, it is important to determine the likely causes and this evaluation partly depends on the degree of difficulty in controlling blood pressure.</p> <p>It is recommended that clinicians should look for the clinical clues that suggest secondary hypertension as it is too expensive and time consuming to perform a complete evaluation for secondary hypertension in every hypertensive patient.</p> <p>The most common causes of secondary hypertension among young adults are hypothyroidism (1.9%), renovascular disease (1.7%), renal insufficiency (1.5%), primary hyperaldosteronism (1.2%), Cushing syndrome (0.5%), and pheochromocytoma (&lt;0.3%).</p> Faisal Ozair Copyright (c) 2021 Faisal Ozair 2021-01-14 2021-01-14 3 1 15 17 10.24018/ejmed.2021.3.1.658 A Case of Sinonasal Squamous Cell Carcinoma with Secondary Involvement of the Orbit <p>We report clinical characteristic, imaging studies, and management of a rare case of expansion epithelial malignancy due to squamous cell carcinoma (SCC). A man was admitted with protrusion of the left eye due to orbital medial tumor mass. The patient had undergone removal surgery, chemotherapy, and radiotherapy two years ago. Imaging and histopathological studies were conducted to determine protrusion of the left eye due to Non-keratinizing sinonasal SCC. The left eye exenteration was conducted and continued with the chemotherapy procedure. This case demonstrates that even aggressive and repetitive surgical may not be adequate in preventing worse outcomes.</p> Putu Yuliawati Ni Putu Dharmi Lestari Copyright (c) 2021 Putu Yuliawati, Ni Putu Dharmi Lestari 2021-01-15 2021-01-15 3 1 18 20 10.24018/ejmed.2021.3.1.656 Complete Stenosis of the Uretero Vesical Junction in Urogenital Tuberculosis: Management and Evolution <p>Urogenital tuberculosis continues to be a major health problem around the world due to the epidemic of HIV infection.</p> <p>We report the case of a 40-year-old patient followed for urogenital tuberculosis and who presented during her follow-up a complication of her disease type ureteral stenosis, managed by endoscopic route.</p> <p>We try through our work to focus on the value of surveillance after anti-bacillary treatment in order to watch for complications and act in an innocuous way.</p> O. Elidrissi M. Rkik W. Bai Y. Ghannam M. Dakir A. Debbagh R. Aboutaieb Copyright (c) 2021 O. Elidrissi, M. Rkik, W. Bai, Y. Ghannam, M. Dakir, A. Debbagh, R. Aboutaieb 2021-01-18 2021-01-18 3 1 21 23 10.24018/ejmed.2021.3.1.669 Usefulness of Pirfenidone in Covid Lung: A Case Series <p>The year 2020 has been plagued by the COVID‑19 pandemic that has resulted in an additional 1,800,000 deaths worldwide. Many patients who recover from Covid-19 later present with shortness of breath and fibrosis of the lungs, while some take a long time to recover from the initial infection. A drug such as pirfenidone, which has been used for the treatment of idiopathic pulmonary fibrosis, could offer additional benefits by reverting pulmonary fibrotic damage. Here we describe a case series of five patients where addition of this drug showed marked improvement in symptoms and radiological findings. Apart from the efforts regarding understanding the pathophysiology of this new disease, we must also evaluate the proportion of patients that develop chronic lung disease due to fibrosis following COVID-19 recovery. Certainly, more attention should be given to new studies to determine the actual benefit of pirfenidone in patients with pulmonary fibrosis as a result of Covid-19 infection.</p> Abdul Basit Ibne Momen Farhana Khan Sadia Saber Amrin Sultana Rafa Faaria Alam Sheikh Golam Raihan Mohammad Monower Hossain Md Tarek Alam Copyright (c) 2021 Abdul Basit Ibne Momen, Farhana Khan, Sadia Saber, Amrin Sultana, Rafa Faaria Alam, Sheikh Golam Raihan, Mohammad Monower Hossain, Md Tarek Alam 2021-01-19 2021-01-19 3 1 24 26 10.24018/ejmed.2021.3.1.670 New Concept of Ocular Implications in COVID-19 Infection: A Brief Review <p>Coronavirus disease 2019 is a novel pneumonia-like respiratory disease caused by the infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus can invade the human body through various intermediaries, including through the eye. The presence of a coronavirus invasion in the eye may cause several ocular manifestations, which can be an initial clinical finding of a coronavirus infection in the host body. On the other hand, it can also cause systemic complications that may affect the eyes. This review will discuss in more detail how the coronavirus can infect humans through the eye, explain its manifestations, and briefly explain the proper and prompt management steps that must be taken.</p> Apen Hoddor Silaban Copyright (c) 2021 Apen Hoddor Silaban 2021-01-07 2021-01-07 3 1 1 5 10.24018/ejmed.2021.3.1.630 Obesity and Non-Alcoholic Fatty Liver Disease: Pathophysiology and Management Focused <p>The continuing rise of obesity epidemic in the global population has been markedly associated with the escalating occurrence and severity of non-alcoholic fatty liver disease (NAFLD). This condition represents a complex metabolic imbalance, primarily characterized by excessive intrahepatic accumulation of triglycerides, known as hepatic steatosis. This pathophysiological process is initiated by the disproportionation between the uptake of dietary fatty acids in plasma, as well as the increase of <em>de novo</em> fatty acid synthesis, which is not equally accompanied by the exportation and oxidation of fatty acid in the form of triglycerides. As mentioned earlier, the underlying metabolic process becomes a significant risk factor for developing cardiometabolic complications, involving type 2 diabetes mellitus, insulin resistance, and dyslipidemia. This review presents a comprehensive understanding of the pathogenesis and pathophysiology of obesity and NAFLD to determine innovative&nbsp;management approaches for the prevention and treatment of the disease.</p> . Febyan Norman Delvano Weky Copyright (c) 2021 . Febyan, Norman Delvano Weky 2021-01-07 2021-01-07 3 1 6 12 10.24018/ejmed.2021.3.1.645 A Review of Intravesical Prostatic Protrusion in the Evaluation and Treatment of Benign Prostatic Enlargement <p>The evaluation of severity of symptoms, tracking complications, choosing effective and efficient approach to treatment, and prognosis is important in benign prostatic enlargement (BPE) patients. Measurement of intravesical prostatic protrusion (IPP) is an easy, affordable and non-invasive marker for benign prostatic obstruction with a high diagnostic value. This study aims to undertake a descriptive review of current literature for the role of IPP in the evaluation and treatment of patients with BPE. Relevant articles written in English language were retrieved from PubMed and Google Scholar. Keywords used for searching articles included intravesical prostatic Protrusion and Benign Prostatic Enlargement/ hyperplasia/ Obstruction; evaluation; and treatment. Papers published between January 1990 and October 2020 were extracted and evaluated. The analyzed studies showed that IPP can be assessed by various modalities and is important in the evaluation of symptom severity, tracking progression and complications of disease, choosing treatment option and prognostication. It is important that IPP be always assessed at the point of initial evaluation of BPE patients.</p> Balantine U. Eze Okwudili C. Amu Jude A. Edeh Copyright (c) 2021 Balantine U. Eze, Okwudili C. Amu, Jude A. Edeh 2021-01-13 2021-01-13 3 1 13 17 10.24018/ejmed.2021.3.1.648 Herd Immunity in India: A Review <p>Herd Immunity is a brilliant solution to tackle and control global pandemics, if taken proper route for immunization such as through vaccination. It is defined as the number of immune individuals against a transmissible virus in a completely susceptible population. The term herd protection or herd effect is the protection to the whole population due to herd immunity. Herd immunity threshold is the minimum proportion of immune population required for herd effect or herd protection. To calculate the threshold, we use basic reproduction number (R<sub>0</sub>) to measure the rate of transmission of pathogen, in this case SARS-CoV-2. However, a better measure is effective reproduction number (R<sub>e</sub>). India is major example of herd immunity. Despite strict lockdown and other Covid measure, due to already crowded area the virus could spread fast and to vast majority of people if one of them were to catch it. This explains the steady decline in the number of coronavirus cases in India. At the end, until an approved effective vaccination available, public will still need to follow all the&nbsp;<strong>C</strong>DC guidelines in order to avoid the large deaths along with natural infection.</p> Sheema Fatima Khan Copyright (c) 2021 Sheema Fatima Khan 2021-01-19 2021-01-19 3 1 18 21 10.24018/ejmed.2021.3.1.671