European Journal of Medical and Health Sciences https://ejmed.org/index.php/ejmed European Journal of Medical and Health Sciences en-US editor@ejmed.org (Editor-in-Chief) editor@ejmed.org (Support) Fri, 06 Nov 2020 09:47:46 -0500 OJS 3.1.1.4 http://blogs.law.harvard.edu/tech/rss 60 Association of Depression with Academic Performance Among Final Year MBBS Students of Rawalpindi Medical University, Pakistan https://ejmed.org/index.php/ejmed/article/view/529 <p>Depression is a typical mental illness among students, particularly medical students, because of their extremely competitive learning environment. Depression negatively affect the cognitive abilities and consequently the academic performance of students later on their performance as a physician. This study aims to evaluate the association of depression with academic performance among final-year MBBS student of Rawalpindi Medical University. This may make available new opportunity to bring enhancement in academic performance of students. This descriptive cross-sectional study was conducted on final-year MBBS students of Rawalpindi Medical University in November 2019. Data was collected through Center for Epidemiologic Studies Depression Scale Revised-10 (CESD-R-10) and self-structured questionnaire which was designed to get information regarding demographic details and marks in last professional examination. Students suffering from any diagnosed physical and mental illness were excluded. Out of 335 students initially selected for study, 307 returned duly filled questionnaires so final sample size was 307. Data analysis was carried out using SPSS v.25.0. Various statistical tests including Independent sample t-test, chi-square test and Pearson’s correlation, and linear regression were applied to evaluate the study variables. Statistically significant and strong negative association was observed between depression and academic performance of students (p = 0.000 for independent sample t-test). For association’s direction and strength between depression and academic performance, Pearson’s correlation coefficient was -0.713 (p= 0.000). Difference in depression score between male and female students (p=0.015) and between boarders and non-boarders (p=0.000) was significant. Similarly, the difference of marks in last professional examination between boarders and non-boarders (p=0.000) was significant, however it was insignificant between male and female students (p=0.135). The simple linear regression model was valid with p-value of 0.000 for F test. Unstandardized regression Coefficient (B) was -10.74. R² was 0.51 (51%). Our study shows an overall high prevalence of depression among final year MBBS medical students, especially among boarders and female students. Significant and strong negative association between depression and academic performance is found, which means that increase in depression decreases the academic performance of students and vice versa. So, by applying suitable interventions for alleviation of depression we can improve academic performance of students.</p> Tayyab Mumtaz Khan, Somia Bibi, Eisha Shoaib, Hafiz Abu Sufian, Ali Imran Dhillon, Madeeha Mumtaz Copyright (c) 2020 Tayyab Mumtaz Khan, Somia Bibi, Eisha Shoaib, Hafiz Abu Sufian, Ali Imran Dhillon, Madeeha Mumtaz http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/529 Sat, 07 Nov 2020 05:11:30 -0500 An Analysis of the Relationship between Physical Activity, Dietary Patterns and Obesity in Elderlies in the Work Area of the Community Health Center of Johan Pahlawan of West Aceh Regency https://ejmed.org/index.php/ejmed/article/view/536 <p>Obesity is a condition where there is accumulation of excess fat in the body. Overweight and obesity cause adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. The work area of the Community Health Center (Puskesmas) of Johan Pahlawan is the region with the highest incidence of obesity in West Aceh with 592 cases and obese patients aged 55-70 years as many as 234 cases. This study aims to determine the relationship between physical activity, dietary patterns and the incidence of obesity in the elderly in the work area of Puskesmas of Johan Pahlawan of West Aceh Regency. This study is an analytical study with cross-sectional design. The sample in this study were all the elderly in the work area of Puskesmas of Johan Pahlawan of West Aceh Regency. The sample was taken using the cluster sampling method, with a total of 95 people. The data analysis technique used was the Spearman’s rank correlation test. It could be concluded from this analysis that there was a relationship between the incidence of obesity and physical activity (p-value = 0,000 &lt;α = 0.05, r = 0.389); and dietary patterns (p-value = 0,000 &lt;α = 0, 05, r = 0.284). In multivariate analysis, the data analysis technique used was multiple logistic regression test. From this analysis, it could be concluded that there was a relationship between the incidence of obesity and physical activity and dietary patterns (p-value = 0,000 &lt;α = 0.05). Physical activity had the highest coefficient value (OR = 0.392) compared to dietary patterns, which indicated that those who had bad physical activity would have a risk of obesity 0.392 times more than those with bad dietary patterns. It is recommended for the Health Department to work together with nutritionists in dealing with obesity problems that occur in the elderly, create special activities to reduce the risk of obesity in the community, and encourage the community to be more active in doing physical activity, such as doing regular exercise.</p> . Zakiyuddin, . Fitriani, . Azwar, . Ishalyadi Copyright (c) 2020 . Zakiyuddin, . Fitriani, . Azwar, . Ishalyadi http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/536 Mon, 09 Nov 2020 09:48:18 -0500 Neutropenia is Less Frequent in Patients than in General Population: A Benign (Ethnic) Neutropenia Study https://ejmed.org/index.php/ejmed/article/view/538 <p><em>Background:</em> Benign (ethnic) neutropenia (BN) is an inherited condition, common in many parts of the world, and often undiagnosed. It should be differentiated from other types of neutropenia which increase the risk of infections.</p> <p><em>Objective:</em> We aimed to ascertain the frequency of neutropenia in patients from a population (citizens of the United Arab Emirates) with a known high frequency of BN (10.7%) to assess how often clinicians might be compelled to differentiate benign neutropenia from other types of neutropenia.</p> <p><em>Methodology:</em> Study subjects were 27,392 Emirati inpatients and outpatients of all ages in a general hospital. They had 55,935 absolute neutrophil counts (ANC). Patients were defined to have neutropenia if the ANC was &lt;1.5x109/L. The frequency of neutropenia was analyzed against several relevant variables.</p> <p><em>Results:</em> Among patients who had one test, the overall frequency of neutropenia (5.3%) was half that in a healthy population (10.7%) in earlier study (p &lt; 0.0001). The prevalence of neutropenia was lower in hospitalized (3.5%, 132/3,769) than in non-hospitalized (9.2%, 510/5,570) patients (p&lt;0.0001), where it was similar (p=0.13) to that in the general population (10.7%, 110/1032). While none of the 282 pregnant women at the time of delivery had neutropenia, it was most common among pediatric outpatients (15.1%, 75/497). Neutropenia was more frequent in patients who had more ANC determinations: one test, 5.3%; two tests, 7.8%; three and more tests, 12.4% (p&lt;0.00001).</p> Srdjan Denic, Sami Shaban, Hassib Narchi, Abdul-Kader Souid Copyright (c) 2020 Srdjan Denic, Sami Shaban, Hassib Narchi, Abdul-Kader Souid http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/538 Thu, 12 Nov 2020 08:45:05 -0500 Fertility Behaviour of Adolescent Mothers in Northern Nigeria and Neonatal Mortality Risk: Mediating Effect of Quality Maternal Health Services https://ejmed.org/index.php/ejmed/article/view/514 <p>Background<em>:</em> Despite rising prevalence of high-risk birth and adverse birth outcome among adolescent mothers in Nigeria, there is paucity of studies relating childhood mortality risk with fertility behaviour of adolescent mothers. This study examines fertility behaviour of adolescent mothers in northern Nigeria and neonatal mortality risk.</p> <p>Methods: Data were derived by pooling together the three most recent Nigeria Demographic and Health Surveys (NDHS, 2008, 2013 and 2018). The sample size comprises of weighted sample of 3,739 adolescent mothers 15-19 years with 5, 274 live births for the period under consideration. Survival analysis (cox proportional hazard model) was used to estimate the hazard of neonatal mortality risk as a result of risky fertility behaviour.</p> <p>Results: Quality of maternal health service utilization was poor among (73.0%) of the adolescent mothers. The independent effect of adolescent fertility behaviour revealed a rise in hazard for neonatal mortality, with increasing high risk fertility behaviour, single high-risk (HR=2.69, p&lt;0.001) and multiple high risk (HR=6.04, p&lt;0.001). Adjusting for quality of maternal health service utilization, resulted in reduced hazard for neonatal mortality, though the result did not reach statistical significance (p&gt;0.05). Adjusting for maternal, child characteristics and quality of maternal health service utilization, resulted in reduced hazard for neonatal mortality, though, the effect of risky fertility behaviour remained insignificant. Multiple birth babies were however, associated with elevated hazard for neonatal mortality (HR=11.4, p&lt;0.05) relative to single birth babies.</p> <p>Conclusion: Adolescent fertility behaviour was associated with elevated hazard for neonatal mortality.</p> Matthew A. Alabi, Motunrayo I. Fasasi, Mary O. Akanbi Copyright (c) 2020 Matthew A. Alabi, Motunrayo I. Fasasi, Mary O. Akanbi http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/514 Fri, 13 Nov 2020 08:19:14 -0500 Obesity Management in Primary Health Care: Front-Line Providers’ Experiences and Views https://ejmed.org/index.php/ejmed/article/view/549 <p>As in the rest of the world, obesity in Oman has increased and according to World Health Organization (WHO) data, prevalence of obesity in 2008 and 2016 were 20.9% and 27% respectively. This study explores primary care physicians’ current strategies and management of obesity, attitude and perceptions towards obesity, educational needs, and their views on long-term follow up.</p> <p>Methods: A cross sectional study was conducted where practicing family medicine physicians from different governorates were invited to participate in an online questionnaire-based survey. Participant were invited via email and responses were kept anonymous. Responses were collected over three weeks in April 2019 and only responses that met inclusion criteria were analyzed with SPSS v22.</p> <p>Results: 77 complete responses met inclusion criteria and female were the majority (67.5%). Half of participants had less than 10 years of experience. Weight and BMI were recorded routinely by two-thirds of participants whereas waist- hip ratio was recorded by only 12%. Weight reduction medications were prescribed by 5.2% and 24% would refer an obese patient to Bariatric center. Main barrier to obesity management and referral was inadequate obesity specialist centers followed by short consultation times. The pathophysiology mechanism of obesity and related hormones was only known by 40.8%. Almost all participants agreed that formal obesity management training should be integrated as part of residency training.</p> <p>Conclusion: Despite the significant number of comorbidities related to obesity and its complications, weight, BMI and other anthropometric measures were not routinely performed. Nationally, the rate of referral to bariatric centers for evaluation is low. Boundaries and challenges do exist and need to be addressed. Obesity and weight management need to be integrated as part of Family Physicians Training Program.</p> Hatem Al-Saadi, Haya Malallah, Jameela Al-Saadi, Narjis ALsheala, Abdullah Al- Balushi, Said Al-Abri, Tariq Al-Saadi Copyright (c) 2020 Hatem Al-Saadi, Haya Malallah, Jameela Al-Saadi, Narjis ALsheala, Abdullah Al- Balushi, Said Al-Abri, Tariq Al-Saadi http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/549 Fri, 13 Nov 2020 09:13:54 -0500 Neurologic Manifestations of SARS-CoV-2, the Virus that Causes COVID-19 https://ejmed.org/index.php/ejmed/article/view/533 <p>Coronaviruses have been associated with many outbreaks in the past and the recent pandemic caused by SARS-CoV-2 has spread around the globe due to its high transmission rate. SARS-CoV-2 has reported to be associated with respiratory and cardiac complications, but recent case series and case reports of COVID-19 patients suggest that it is also associated with neurological manifestations. The most commonly observed neurological manifestation are headache, anomia, ageusia, dizziness, delirium and the complications include Guillain-Barre syndrome (GBS), acute encephalitis, acute myelitis, and cerebrovascular disorders. The pathways leading to neuronal damage are the retrograde neuronal and hematogenous pathway. This paper is aimed to explain the neurological manifestations associated with COVID-19 patients and the possible pathophysiological mechanisms of neuronal invasion.</p> Hassan Naji Copyright (c) 2020 Hassan Naji http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/533 Fri, 13 Nov 2020 09:27:36 -0500 Comparative Analysis of Dacryo Cysto-Rhinostomy: External Versus Endoscopic https://ejmed.org/index.php/ejmed/article/view/523 <p>Dacryocystorhinostomy (DCR) is a surgical procedure that restores communication between the tear sac and the adjacent nasal cavity. Our work consists of a comparative study of the results of external dacryocystorhinostomy (EX-DCR) versus endoscopic endonasal dacryocystorhinostomy (EN-DCR), whose rate of therapeutic failure by endoscopic route estimated at 20% against only 7% in the case of external surgery.</p> Joumany Brahim Salem, Mehdi Khamaily, Imane Tarib, Sidi Dahi, Rachid Zarrouk, Yassine Mouzari, Fouad El Asri, Karim Reda, Abdelbarre Oubaaz Copyright (c) 2020 Joumany Brahim Salem, Mehdi Khamaily, Imane Tarib, Sidi Dahi, Rachid Zarrouk, Yassine Mouzari, Fouad El Asri, Karim Reda, Abdelbarre Oubaaz http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/523 Fri, 13 Nov 2020 16:29:28 -0500 Unexplained Increase in Death Rate during COVID19 Pandemic Mistakenly Attributed to Malaria https://ejmed.org/index.php/ejmed/article/view/545 <p>Background: Since the emergence of COVID-19 pandemic, the world has faced many challenges. In Sudan, Gizera state has shown mysterious symptoms to the residents of a village and has been diagnosed with malaria.</p> <p>Aim: The study was aimed to disprove the diagnosis of malaria, and to find another more convincing explanation that fits with the general features of the disease.</p> <p>Method: A descriptive cross-sectional study was conducted using an electronic questionnaire designed by Google form.</p> <p>Result: The respondents was 402, the distribution of males and females was 51.7% and 48.3%, respectively. 83% were suffered the symptoms in May and June.&nbsp;The most common symptoms were headache, fever, fatigue and joint pain, back pain, sore throat and anosmia, at 60.7%, 49.8%, 47.3%, 33.3%, 37.3%, and 23.3%, respectively. 61.4% seeked health care, 99.9% performed peripheral blood film for malaria and 83% were positive. 77% of those with positive result, 72% of those with negative results, 62% of those who did not seek health care suffered similar symptoms, mainly headache.&nbsp;Also, anosmia is 30%, and 25% for those who have seeked and have not seeked health care, respectively. The recovery period was less than a week in 49% of those with positive results, 57% of those with negative results, and 63% of those who did not seek health care.&nbsp;It was more than two weeks in 9%, 12%, and 4% in the positive, negative, and uncaring, respectively. 56.5% did not notice the mosquitoes in that period, 31% and 11.7% noticed that and did not know, respectively.</p> <p>Conclusion: The most likely diagnosis of these mysterious symptoms is COVID-19.</p> Ibrahim Abdelrhim Ali, Alaaeldeen Mohammed Ahmed Abdeldafia, Abrar Bakry Elmalik, Mohamed Eltayieb Elawad Copyright (c) 2020 Ibrahim Abdelrhim Ali, Alaaeldeen Mohammed Ahmed Abdeldafia, Abrar Bakry Elmalik, Mohamed Eltayieb Elawad http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/545 Sat, 14 Nov 2020 04:44:56 -0500 Feedback to Receivers: Knowledge and Perception of Medical Students in a Public Sector Institute of a Developing Country https://ejmed.org/index.php/ejmed/article/view/553 <p><em>Background</em>: The practice of effective feedback delivery in medical institutes of developing countries lags behind the modern principles of medical education. This demands the need to understand the students’ knowledge and perception regarding received feedback in the setting of a developing country.</p> <p><em>Aims</em>: To assess the level of knowledge and perception of feedback among students. To find the correlation between knowledge and perception. To identify problematic areas in feedback delivery and provide recommendations for rectification.</p> <p><em>Methods</em>: A cross-sectional study conducted in Rawalpindi Medical University Pakistan, in which 480 medical students from 2nd till 5th-year MBBS were evaluated regarding their knowledge and perception about feedback using structured questionnaires.</p> <p><em>Results</em>: The students had a good level of knowledge regarding The concept of feedback. However, they had a negative perception of the feedback given to them by their teachers. There was no correlation between mean knowledge and perception scores (r=-0.05, p = 0.272). There was a significant difference between knowledge (p=0.0004) and perception (p=0.02) scores across gender. The difference in mean knowledge scores across academic years was not significant (p=0.267) but this difference was significant for mean perception scores (p=0.001).</p> <p><em>Conclusion</em>: Strategies should be adopted to incorporate feedback into the curriculum for improving the quality of medical education in a developing country.</p> Hamza Waqar Bhatti, Syed Muhammad Jawad Zaidi, Mehwish Kaneez, Javeria Awan, Rashid Naeem Khan, Umair Tahir Copyright (c) 2020 Hamza Waqar Bhatti, Syed Muhammad Jawad Zaidi, Mehwish Kaneez, Javeria Awan, Rashid Naeem Khan, Umair Tahir http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/553 Sat, 14 Nov 2020 05:08:57 -0500 Knowledge of Cervical Cancer and Its Screening Amongst Female Students of a Tertiary Institution in South-South Nigeria https://ejmed.org/index.php/ejmed/article/view/530 <p><em>Background: </em>Cervical cancer is one of the commonest cancers in women. It is the commonest cause of cancer related death in Africa. It is one of the cancers that have well known screening methods. In developed societies with standard protocol for screening, the morbidity and mortality following the disease have been greatly reduced. There is paucity of knowledge of cervical cancer and its screening methods in Yenagoa.</p> <p><em>Objectives: </em>To determine the knowledge of cervical cancer and its screening methods in female students of a Tertiary educational institution.</p> <p><em>Methods: </em>This was a cross-sectional descriptive study that was conducted amongst the female students of Federal University Otuoke. Information about their socio-demographic characteristics, knowledge of cervical cancer and the screening methods was obtained using a questionnaire.</p> <p><em>Results: </em>A total of four hundred and twenty four (424) female students of the Federal University Otuoke were enrolled for the study. The mean age of the respondents was 21.0±3.4 years. The predominant age group was 15-20 years (50.6%). One hundred and eighty three respondents (57.9%) were aware of cervical cancer and the age groups 21-25 years were most aware of cervical cancer. Age was found to influence awareness of cervical cancer. (x2=12.8; df=3; p&lt;0.05). A total of eighty one respondents 26.9% were aware of Pap smear. Age was found to influence the awareness of Pap smear (x2=12.8; df=3; p&lt;0.05).</p> <p><em>Conclusion: </em>Our study showed that awareness of cervical cancer and the role of Pap smear in the screening of cervical cancer was low amongst the female students of the Federal University Otuoke. Hence the need to make every effort to increase the awareness of this condition and the screening methods amongst these female undergraduates, who are at the prime of their age and at the greatest risk of developing this condition, especially in our societies that lack well organized screening protocols.</p> D. O. Allagoa, O. J. Agbo, A. O. Eguvbe, P. W. Alabrah Copyright (c) 2020 D. O. Allagoa, O. J. Agbo, A. O. Eguvbe, P. W. Alabrah http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/530 Mon, 16 Nov 2020 03:45:06 -0500 Chromosome HeatMap in CDK Patients as Defined by Multiregional Sequencing on Illumina MiSeq Platform https://ejmed.org/index.php/ejmed/article/view/525 <p>Renal failure and kidney disease are major concerns worldwide and are commonly coupled to diseases like hypertension, diabetes, obesity, and hypercholesterolemia. We undertook this study to explore the scope of genetic spectrum underlying the physiopathology of end-stage renal disease (ESRD) using whole exome sequencing (WES) on genomic DNA (gDNA) from 12 unrelated patients in younger ages. We have performed WES on 12 patients in stage of ESRD and analyze the FASTQ data through GATK pipeline. Here, we report for the first time a novel approach of establishing the severity and the magnitude of a disease on different chromosomes and associated karyotypes using chromosome Heatmap. The chromosome Heat will provide us with a road map to narrow down mutations selection leading us to SNPs characterization. Our preliminary results presented in the form of chromosomes HeatMap prelude our ongoing works which consist in identifying and characterizing new genes involved in the problem of renal diseases, results that depict the magnitude of the uncovered genes mutations and their biological implications related to the genome of these patients.</p> Mohammad F. Fazaludeen, Aymen A. Warille, Mohd Ibrahim Alaraj, Edem Nuglozeh Copyright (c) 2020 Mohammad F. Fazaludeen, Aymen A. Warille, Mohd Ibrahim Alaraj, Edem Nuglozeh http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/525 Mon, 16 Nov 2020 07:55:30 -0500 Barriers to Learning During Clinical Rotations in the Emergency Department: The Perspective of Students in a Public Sector Institute of a Developing Country https://ejmed.org/index.php/ejmed/article/view/554 <p><em>Background:</em> Clinical learning is the crux of medical education. Students perceive many barriers to effective clinical learning due to transition, poor supervision, and lack of orientation. There is an urgent need for recommendations to alleviate these barriers and improve the quality of medical education in a public sector institute of a developing country.</p> <p><em>Aims:</em> The study aims to identify the barriers in clinical learning perceived by the students during their clinical rotations in emergency. The study also aims to provide recommendations to alleviate these barriers.</p> <p><em>Methods:</em> A cross-sectional study conducted among 300 students from a public sector institute of Pakistan. The perception of clinical learning was assessed using a structured questionnaire in students attending medical and surgical emergency ward. Independent samples t-test and ANOVA were used to assess differences in perception scores across gender and academic years.</p> <p><em>Results:</em> The mean perception score was 52.0±11.74. There was a significant difference in perception scores across academic years (p=0.028) with the final year having lower perception scores than the junior students. The mean scores of items in domain 1 (Transition and stress) and domain 4 (Supervision and feedback) were lower indicating a negative perception in these domains.</p> <p><em>Conclusions:</em> Lack of clinical orientation, non-integration of the clinical curriculum in preclinical years, poor supervision, lack of resources, and a crippled feedback delivery system are barriers to clinical learning. Interventions such as integration of clinically orientated curriculum, teacher training, student-centered teaching methodology, and development of an effective feedback delivery system must be employed for quality clinical learning during rotations.&nbsp;</p> Syed Muhammad Jawad Zaidi, Hamza Waqar Bhatti, Mehwish Kaneez, Fazila Hassan, Abdullah Bin Zubair, Syed Faheem Bukhari, Muhammad Waqar Younas, Muhammad Zubair Satti Copyright (c) 2020 Syed Muhammad Jawad Zaidi, Hamza Waqar Bhatti, Mehwish Kaneez, Fazila Hassan, Abdullah Bin Zubair, Syed Faheem Bukhari, Muhammad Waqar Younas, Muhammad Zubair Satti http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/554 Thu, 19 Nov 2020 05:33:57 -0500 Association of Acute Otitis Media with Breast Feeding Position Among Infants in a Tertiary Care Hospital of Pakistan https://ejmed.org/index.php/ejmed/article/view/563 <p>Acute otitis media (AOM) is the commonest disease of childhood. High incidence of AOM might be due to immature Eustachian Tube and immaturity of immune system. Exclusive breast feeding is protective against acute otitis media, however, improper breastfeeding &nbsp;position can increase AOM occurrence in infants. This study aims to assess the association of improper breastfeeding position with occurrence of Acute otitis media in infants and to assess association of Maternal educational levels with feeding positions. 220 breastfed infants satisfying inclusion criteria with diagnosed AOM were enrolled. Study was conducted over a period of 6 months from August 2019 to January 2020. Demographic details and Detailed history regarding feeding positions and maternal educational levels were obtained through a Self-structured proforma from parents. Data analysis was done through descriptive statistics and chi square test and p value less than 0.5 was set significant. Out of 220 infants, 123(55.90%) were male and 97(44.10%) were females. AOM was more common in male infants than female infants, however it was not statistically significant(p=0.169). The mean age for enrolled infants(1-12months) was 6.90(±3.413). Statistically significant association between increase incidence of AOM and breastfeeding position was found(p=0.032). We also found a statistically significant association between maternal educational levels and breastfeeding position (p= 0.000). In this study, we have noted that Breastfeeding in supine position is associated significantly with increase in incidence of AOM. Feeding positions are statistically associated with Maternal Educational levels.</p> Samia Tul Rasool, Sana Mansoor, Tayyab Mumtaz Khan, Ashar Alamgir, Maida Meer, Fakeha Masood, Shahrukh Khan, Madeeha Mumtaz, Jehanzeb Akram, Hina Mansoor Copyright (c) 2020 Samia Tul Rasool, Sana Mansoor, Tayyab Mumtaz Khan, Ashar Alamgir, Maida Meer, Fakeha Masood, Shahrukh Khan, Madeeha Mumtaz, Jehanzeb Akram, Hina Mansoor http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/563 Sat, 21 Nov 2020 05:44:25 -0500 Platelet-Rich Plasma in the Management of Chronic Endometritis Treatment in Women with Reproductive Health Disorders https://ejmed.org/index.php/ejmed/article/view/560 <p><em>Background: </em>Chronic endometritis (CE) is one of aggressive factor of infertility and reproductive losses.</p> <p><em>Objective:</em> We aimed to assess the effectiveness of using platelet-rich plasma (PRP) treatment of chronic endometritis (CE) treatment in women with infertility (PI) and recurrent pregnancy losses (RPL).</p> <p><em>Material and methods</em>: In this non-randomized clinical trial, women aged 22-45 years with CE diagnosed by positive CD 138 between February 2017 and December 2019 were included. Were investigated 65 women - 30 patients with RPL and 35 women with PI and unsuccessful attempts at IVF. PRP therapy was performed paracervical ( 6 ml) and intrauterus ( 1,5 ml) once a week for 4 -8 weeks. Control of the treatment of CE was performed by endometrial biopsy pipelines 15-20 days after the last PRP.</p> <p><em>Results: </em>After carrying out 4 procedures of combined paracervical and intrauterine PRP, CE was cured in 70-77% of women (p &lt;0.05); after 8 procedures - 97% (p &lt;0.01).</p> <p><em>Conclusions:</em> Combined intrauterine and paracervical PRP therapy is an effective treatment for CE in women with PI and RPL.</p> V. O Sklyarova, K. L. Shatylovich, A. L. Filipyuk, P. O. Sklyarov, R. A. Chajkivskyj Copyright (c) 2020 V. O Sklyarova, K. L. Shatylovich, A. L. Filipyuk, P. O. Sklyarov, R. A. Chajkivskyj http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/560 Mon, 23 Nov 2020 04:46:01 -0500 Defects in the Existing Theory of Skeletal Muscle Contraction and Postulation of a New Theory https://ejmed.org/index.php/ejmed/article/view/573 <p>In 1954 , two independent research teams, one consisting of Andrew F. Huxley and Rolf Niedergerke from the University of Cambridge, and the other consisting of Hugh Huxley and Jean Hanson from the Massachusetts Institute of Technology proposed the theory of skeletal muscle contraction [1]. They used electron microscopy to study the details of muscle filaments. The structure was studied in detail by then, but the mechanism of skeletal muscle contraction was not defined. Based on various assumptions about the actin and myosin filaments of muscle, later they postulated a theory called “sliding filament theory”. When this theory is scrutinized in detail, I find that there are a lot of defects in this theory, which I have pointed out and I have made an attempt to postulate a different mechanism for the skeletal muscle contraction.</p> O. Sasikumari Copyright (c) 2020 O. Sasikumari http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/573 Tue, 24 Nov 2020 08:18:47 -0500 Serum Cholinesterase Level as a Marker of Systemic Low-Grade Inflammation in Isolated Systolic Hypertension: A Cross-Sectional Study https://ejmed.org/index.php/ejmed/article/view/534 <p><em>Background:</em> Autonomic regulation of local and systemic inflammation through the ‘cholinergic anti-inflammatory pathway’ may have role in persistence of low-grade systemic inflammation in isolated systolic hypertension (ISH). The augmented activity of the enzyme cholinesterase (ChE) leads to degradation of the main anti-inflammatory neurotransmitter ‘acetylcholine’ of this pathway. Despite the role of inflammation in hypertension, serum level of cholinesterase enzyme has not been determined till now in ISH. The study aimed to measure the serum levels of inflammatory marker ChE in comparison to high sensitivity C-reactive protein (hsCRP) to predict the presence of low-grade systemic inflammation and their correlation with blood pressure in ISH patients.</p> <p><em>Methods:</em> A cross-sectional study was conducted in ISH patients (n=30; mean age, 51.00±1.24 years; male/female (M/F) number=18/12). Age and sex matched healthy subjects (n=30, mean age, 51.86±1.40 years; M/F=16/14) were taken as control. Subjects were divided into three groups based on hsCRP levels; group I (healthy: hsCRP≤1.0mg/L), group IIa (patients with mild inflammation: hsCRP≤1.0mg/L), group IIb (patients with moderate to severe inflammation: hsCRP 1.0-10.0mg/L). Overnight fasting blood samples were collected and ChE and hsCRP were assessed using Cholinesterase Liqui-Check and hsCRP turbi-latex diagnostic kits, respectively.</p> <p><em>Results:</em> hsCRP and ChE levels were found significantly high in hypertensive patients than in healthy subjects (<em>p</em>&lt;0.05). In patients at mild stage of inflammation, there was an increase in both ChE and hsCRP, but not linearly as they had no significant correlation with each other. But at moderate to severe inflammation stage, there was a linear rise in both hsCRP and ChE levels. SBP, DBP and PP were significantly correlated with both ChE and hsCRP in patients (<em>p</em>&lt;0.01). Moreover, as the SBP was increased from grade I to II, both hsCRP and ChE levels were also increased.</p> <p><em>Conclusion:</em> Many factors interplay in propagating inflammatory cascade in ISH and all biomarkers of inflammation may not elevate at same point in time and in linear manner. ChE may act as a marker of low-grade systemic inflammation but its comparison must be tested against a standard marker such as hsCRP in large scale studies for finding its true significance in predicting cardiovascular disease risk.&nbsp;</p> Williamjeet Sidhu, Lovleen Bhatia, Kanchan Vohra Copyright (c) 2020 Williamjeet Sidhu, Lovleen Bhatia, Kanchan Vohra http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/534 Wed, 25 Nov 2020 04:18:57 -0500 Impact of Depression on Food Consumption Frequency among Medical Students of Rawalpindi Medical University, Pakistan https://ejmed.org/index.php/ejmed/article/view/578 <p>Depression is very common and multi-problematic disorder, and it can affect almost all aspects of lives of people including the way people eat, sleep, behave and perform. Depression can also lead to increase in consumption of unhealthy foods. This study is set to assess impact of depression on the consumption frequency of various food groups among final-year medical students of Rawalpindi Medical University Pakistan. This may bring new way to improve physical health through application of interventions for mental health. This descriptive cross-sectional study was conducted in December 2019 among final year medical MBBS students of Rawalpindi Medical University Pakistan. Two questionnaires were used for data collection including, Center for Epidemiologic Studies Depression Scale Revised-10 (CESD-R-10) for depression assessment while a self-structured questionnaire which was designed to get information regarding demographic details and food consumption of various food groups (Fresh foods, Sweet foods, Ready to eat foods, Snack foods and Fast Foods). Students who had any physical and mental illness and irregular dietary habits were excluded. From the total of 307 participants of study, 269 participants gave back properly filled questionnaires, therefore, final sample size became 269. Data analysis was accomplished through SPSS v.25.0. Because of non-parametric nature of data different non-parametric statistical tests including Mann–Whitney test, Kruskal–Wallis test and Spearman correlation were applied to evaluate the study variables. A p-value less than 0.05 was considered statistically significant. Difference in depression was statistically significant, across gender (p=0.007) and boarding status (p=0.000). Significant differences of depression were also found across intake three frequency levels of sweet foods(p=0.000), fast foods(p=0.000), snack foods(p=0.000), ready to eat foods(p=0.000) and fruits and vegetables(p=0.000). Spearman correlation coefficient was positive for four foods groups including sweet foods (0.426 with p=0.000), fast foods (0.610 with p=0.000), snack foods (0.611 with p=0.000), ready to eat foods (0.649 with p=0.000), while for fruits and vegetables ( -0.640 with p=0.000) it was negative. Positive values of Spearman correlation coefficient for sweet foods, fast foods, snack foods, and ready to eat foods indicate that, increase in depression leads to increase in consumption of these food groups while, negative value for fruits and vegetables indicates that increase in depression leads to reduction in consumption of this food group. Our study results show that depression leads to change in consumption frequency of various food groups. Increase in depression leads to increase consumption frequency of unhealthy food groups including sweet foods, fast foods, snack foods, ready to eat foods while increase in depression leads to decrease consumption frequency of fruits and vegetables. Therefore, by applying suitable intervention for the alleviation of depression we can improve dietary habits and consequently physical health.</p> Tayyab Mumtaz Khan, Somia Bibi, Samia Tul Rasool, Manahil Jamil, Shahrukh Khan, Hajrah Shafique, Syeda Uroosa Jafri, Huma Ishfaq, Sania Salamat, Umama Fatima Iqbal, Huma Amjad, Madeeha Mumtaz Copyright (c) 2020 Tayyab Mumtaz Khan, Somia Bibi, Samia Tul Rasool, Manahil Jamil, Shahrukh Khan, Hajrah Shafique, Syeda Uroosa Jafri, Huma Ishfaq, Sania Salamat, Umama Fatima Iqbal, Huma Amjad, Madeeha Mumtaz http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/578 Sat, 28 Nov 2020 14:05:01 -0500 Attitude of Future Doctors Towards Smoking: Are They Really Propagating Ideal Lifestyles? https://ejmed.org/index.php/ejmed/article/view/576 <p>We conducted this study to assess the attitude and practices of medical students towards tobacco smoking whilst knowing its hazards. This cross-sectional study was conducted by inviting students to complete an online anonymous questionnaire to ensure confidential, valid responses from January 2020 to March 2020. All of the MBBS students, from first year to final year, who were studying in that time period were included in this study. All statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0. (Armonk, NY: IBM Corp.). Of the 1700 students, 385 students aged 17 to 26 years (mean age, 21 years) participated in this study. The prevalence of smoking among students was 23.1%. Smoking was significantly related to older age (p=0.000). Total of 137 (35.58%) students were passive smokers whereas 51 (13.24%) students were passive smokers in addition to being active smokers (P=0.000). The main motives for starting smoking were curiosity (53.93%), peer pressure (41.60%), and increased concentration (38.20%). Most of the students had knowledge of the prominent hazards of tobacco smoking like chronic lung diseases (95.06%), cancer in general (94.02%), and cardiovascular diseases (91.16%) but insufficient knowledge on other hazards. Educational lessons about smoking hazards (61.8%), prevention of smoking at universities, schools, and hospitals (59.0%), and increasing taxes on cigarettes (57.1%) were some suggestions put forward by students to prevent smoking. Smoking cigarettes remains a major threat among medical students. Although the vast majority of students showed a better attitude towards cigarette smoking prevention, they still lack sufficient knowledge about smoking hazards.</p> Mian Muhammad Hassan Ahmed, Shizray Haral, Adeela Komal, Faiza Rameen Shahid, Muhammad Moiz Muzaffar, Tayyab Mumtaz Khan Copyright (c) 2020 Mian Muhammad Hassan Ahmed, Shizray Haral, Adeela Komal, Faiza Rameen Shahid, Muhammad Moiz Muzaffar, Tayyab Mumtaz Khan http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/576 Mon, 30 Nov 2020 10:17:08 -0500 Mother’s Nutritional Knowledge and Practice: A study on Slum Area of Khulna City https://ejmed.org/index.php/ejmed/article/view/582 <p>Child health and nutrition much depend on the mother’s knowledge and conscious. We measure mother’s nutritional knowledge and practice affecting child health and nutrition in slum areas of Khulna city in Bangladesh. We find that mothers substantially lack nutritional related knowledge, where many cannot even apply nutritional related knowledge in their daily life mainly due to economic affordability of nutrient food and other required health care services. The research also identifies factors affecting nutritional practices in slum households. The research suggests taking measures to increase nutritional knowledge of mothers and to provide nutrient foods and health care services to the disadvantaged pregnant and mothers with newborn babies.</p> Papia Sultana, Khan Mehedi Hasan Copyright (c) 2020 Papia Sultana, Khan Mehedi Hasan http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/582 Sun, 29 Nov 2020 00:00:00 -0500 Risky Fertility Behavior, Breastfeeding Practices and Neonatal Mortality Risk: Evidence from Repeated Cross-Sectional Nationally Representative Data https://ejmed.org/index.php/ejmed/article/view/581 <p><em>Background</em>: Notwithstanding government efforts in improving maternal and child health, childhood mortality still remains a serious burden in the country, with neonatal mortality rate of 39 deaths and under-five mortality rate of 132 per 1,000 live births. This has implication on Sustainable Development Goals (SDGs) targeted towards reducing under-fiver mortality rate to 25 deaths per 1,000 live births by the year 2030. This study examined risky fertility behavior, breastfeeding practices, and neonatal mortality risk in Nigeria.</p> <p><em>Materials and methods:</em> This study involved the analysis of secondary data, Nigeria Demographic and Health Survey (pooled dataset of the three most recent surveys, NDHS, 2008, 2013 and 2018). The sample size was a weighted sample of 94,062 women aged 15-49 years with 172, 252 live births for the ten years period. Descriptive statistics and cox-proportional hazard model were performed using Stata 14.1 software.</p> <p><em>Results:</em> Nearly two thirds (64.0%) of births were high risk. The practice of breastfeeding among the women was quite poor, just (39.5%) initiated breastfeeding within one hour of childbirth, though (74.0%) reported breastfeeding their child for a minimum of 12 months. The independent effect of risky fertility behavior (RFB) was associated with elevated hazards of neonatal mortality, with the highest risk observed among births belonging to the multiple high-risk group (HR=2.1, p&lt;0.01). Adjusting for breastfeeding practices, maternal/child characteristics and maternal health seeking behavior was associated with elevated hazard of neonatal mortality with the highest hazard observed among births belonging to the multiple high-risk group (HR=1.76, p&lt;0.05). Other factors associated with elevated hazard for neonatal mortality are sex of the child, maternal level of education and breastfeeding duration.</p> <p><em>Conclusion:</em> RFB was associated with elevated hazard for neonatal mortality, even after adjusting for breastfeeding practices, maternal and child characteristics and maternal health-seeking behavior thereby lending credence to Mosley and Chen theory.</p> Matthew A. Alabi, Grace E. Ihimekpen, Taofeek A. Hassan Copyright (c) 2020 Matthew A. Alabi, Grace E. Ihimekpen, Taofeek A. Hassan http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/581 Mon, 30 Nov 2020 00:00:00 -0500 A Promising Step in Fighting the Opioid Epidemic, Care Plan Implementation for those Presenting to the Emergency Department https://ejmed.org/index.php/ejmed/article/view/586 <p><em>Background:</em> The opioid epidemic has both financial implications and ethical confounders affecting emergency departments across the country. Additionally, patients presenting to the emergency department (ED) seeking opioid administration and prescriptions can be both disruptive and time intensive.</p> <p><em>Objective</em>: To determine long-term effectiveness of ED care plans designed to improve medical care for ED opioid-seeking patients with chronic painful conditions. Methods: A retrospective, cohort observational study.</p> <p><em>Location:</em> a suburban teaching hospital with an annual census of 90,000 patients. The number of ED visits were tallied one year prior (control), and for five consecutive years following initiation. The primary outcome was the number of yearly ED visits in subjects meeting criteria.</p> <p><em>Statistics:</em> Two-tailed Wilcoxon signed-rank test with significance of p&lt;0.05, two tailed. Results: One hundred and twenty patients were enrolled. Twelve were excluded, leaving 108 patients for analysis. Mean yearly ED visits prior to care plan initiation were 7.6 (95% CI 11.9-3.3). Following care plan initiation, mean visits were: one year, 2.3 (95% CI 4.3-0.3); two years, 1.3 (95% CI 2.7-0.0); three years, 1.1(95 % CI 3.1-0.0); four years, 0.8 (95% CI 2.1-0.0); five years, 0.6 (95% CI 1.7-0.0). The five-year total mean reduction in visits was 7.0 (95% CI 8.1- 6.2) (p=0.0001). Conclusions: ED care plans are an effective long-term method to reduce visits in patients with chronic painful conditions who present seeking opioid treatment.</p> F. Fiesseler, R. Riggs, D. Salo, D. Feldman, R. Shih Copyright (c) 2020 F. Fiesseler, R. Riggs, D. Salo, D. Feldman, R. Shih http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/586 Mon, 30 Nov 2020 00:00:00 -0500 Improvements of the US BI-RADS Assessment – A Necessity for a Non-Invasive Positive and Differential Diagnosis of Breast Cancer. Application of the New Full Breast Ultrasonography Concept https://ejmed.org/index.php/ejmed/article/view/585 <p><em>Objective</em>: Despite the engineering progress, the diagnosis of breast cancer (BC) is unsatisfactory due to less specific descriptors and non-anatomical scanning and interpretation, proving that physicians lag behind technology. We aimed to improve the noninvasive positive and differential diagnosis of BC using modern technology applied to the new integrative concept of Full Breast Ultrasonography (FBU): anatomical radial scanning, color Doppler and Strain Sonoelastography (SE).</p> <p><em>Methods</em>: We analyzed retrospectively 1841 consecutive FBUs in 1333 patients from screening, diagnosis, or follow-up, in two centers. We searched three descriptors: the ductal connection of the lesions, the incident angle of the plunging artery, and the SE (Ueno score). We compared the initial BI-RADS assessment with pathological reports or follow-up examinations of benign findings.</p> <p><em>Results</em>: Radial scanning and ductal connection provided a standardized examination of the entire breast, with 100% sensitivity, early detection, precise location, and easy follow-up. We found no correlation BC-Density-Age, but a significant association BC - Benign pathology. The benign lesions, usually multiple, associated the proliferative and secretory types. The incident angle of the plunging artery was the best descriptor for the BC mass-type and associated with a score 4 or 5 Ueno led to PPV of 97.01%, specificity of 99.67%, and accuracy of 99.69%. Inflammatory BC illustrated high glandular strain and diffuse hyperemia.</p> <p><em>Conclusion</em>: FBU had optimal accuracy, independent of the mammographic model, in screening and diagnosis. The vascular angle correlated with strain SE (adapted to the breast heterogeneity) raised the specificity and is recommended for inclusion in US BI-RADS.</p> Aristida Colan-Georges Copyright (c) 2020 Aristida Colan-Georges http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/585 Mon, 30 Nov 2020 00:00:00 -0500 Syncope: A Very Atypical Presentation of COVID-19 https://ejmed.org/index.php/ejmed/article/view/547 <div class="page" title="Page 9">Possible COVID-19 patients have presented commonly to United States&nbsp;Emergency Departments. Patients presenting with cough, fever and shortness of breath are easy to identify as suspected cases. Unfortunately, not all COVID-19 patients present this way. Atypical presentations are a risk factor for healthcare worker (HCW) transmission of this disease. In this case report we describe the unusual case of COVID-19 presenting as syncope without any other risk factors. HCWs need to be aware of atypical COVID-19 presentations and to maintain proper use of personal protective equipment.</div> Richard D. Shih, Paul M. Louis, Scott M. Alter, Patrick G. Hughes, Joshua J. Solano, Lisa M. Clayton Copyright (c) 2020 Richard D. Shih, Paul M. Louis, Scott M. Alter, Patrick G. Hughes, Joshua J. Solano, Lisa M. Clayton http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/547 Fri, 13 Nov 2020 09:47:47 -0500 Hypertension Associated with Coarction (COA) of the Aorta. Case Report from Clinical Experience in Paediatric https://ejmed.org/index.php/ejmed/article/view/544 <p>Coartion of the aorta is a birth defect, in which aorta become narrower than usual and this narrowness differ in the amount from one case to another. Occurring more frequently in boys than girls and the risk increase with family history having, bicuspid aortic valve and in Turner syndrome.</p> <p>It can present with different clinical presentation depending on the severity of the narrowness; weak or no pulse in the feet and blood pressure in the arm much higher than in the legs. The aim of this case report is to emphasize special attention to coartion of aorta as cause of systemic Hypertension, delineate the difference diagnostic approach for systemic hypertension in children and adult and stress the important of doing proper clinical examination of cardiovascular examination and checking the blood pressure even in young children. Such case will help us pay attention to possibility of COA in children with hypertension.</p> Eilaf Mohamednour, Kirsten Wolffsohn Copyright (c) 2020 Eilaf Mohamednour, Kirsten Wolffsohn http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/544 Sat, 14 Nov 2020 10:56:21 -0500 Primary Neuroendocrine Tumor of the Testis Masquerading as Germ Cell Tumor – A Case Report https://ejmed.org/index.php/ejmed/article/view/518 <p>Primary pure neuroendocrine tumors of the testis are rare with a high malignant potential requiring long-term follow-up. Only limited number of studies are available in the literature.</p> <p>In the present study, we describe a case report of a 31 year old young man who presented with a left testicular swelling, initially misdiagnosed as seminoma. Later, after correlating with the morphology and immunohistochemistry the diagnosis of neuroendocrine tumor of testis was concluded.</p> <p>Neuroendocrine tumors cases should be kept in long term follow up, to prevent relapse and recurrence.</p> Sulagna Manna, Suma Mysore Narayana, C. S. Premalata Copyright (c) 2020 Sulagna Manna, Suma Mysore Narayana, C. S. Premalata http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/518 Wed, 18 Nov 2020 11:19:31 -0500 Retroperitoneal Tuberculosis in Pregnancy: A Case Report and Literature Review https://ejmed.org/index.php/ejmed/article/view/559 <p>Tuberculosis is and infectious disease that can affect multiple organs and systems. It can involve the almost the whole body including the abdomen. Retroperitoneal involvement is uncommon, especially during pregnancy. We report the case of a pregnant woman with a retroperitoneal mass whose final diagnosis was tuberculosis, focusing on the timing and difficulties to ensure the diagnosis.</p> José Antonio Díaz-Peromingo Copyright (c) 2020 José Antonio Díaz-Peromingo http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/559 Thu, 19 Nov 2020 06:04:30 -0500 Nalbuphine Use for Postoperative Pain in Bariatric Surgery: Case Series and Rationale https://ejmed.org/index.php/ejmed/article/view/510 <p>Obesity became an epidemic condition worldwide with a significant impact in healthcare and surgical interventions emerged as a treatment for it. Due to their health conditions, obese population are at higher risk of presenting opioids adverse effects. The goal of this study is to assess the potential use of nalbuphine on bariatric surgery according to its beneficial effect as an agonist-antagonist opioid.</p> <p>A total of 93 medical records of consecutive patients were selected retrospectively at Santa Casa de Porto Alegre Hospital from January 2018 to January 2019. Patients were overall women, middle-aged, with obesity grade 3 and with stable comorbidities. Sleeve gastrectomy was the main surgery technique by laparoscopic approach. Anesthesia used was essentially TIVA, with Dipyrone and NSAIDS as the main adjuvants associated. The time to the first requirement of nalbuphine (TFRN) and total dose of nalbuphine in 24h (TDN24) had medians of 80 minutes and 20mg, respectively. Respiratory depression, urinary retention and pruritus were not found in any patients. The only data statistically significant was sex related TDN24, with men using almost twice larger median doses than women.</p> <p>The analgesic properties and adverse effects profile look encouraging in this setting. The female prevalence is a relevant information considering the influence of gender in nalbuphine efficacy. We can see the agreement with this concept observing that the only statistically significant difference in all study was the total dose of nalbuphine in the first 24h postoperative, favoring females.&nbsp;</p> A. R. de Oliveira, F. S. Conter, E. S. Martinelli, A. C. Weston Copyright (c) 2020 A. R. de Oliveira, F. S. Conter, E. S. Martinelli, A. C. Weston http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/510 Sat, 21 Nov 2020 05:54:15 -0500 A Heavily Giant Calcified Hydatid Cyst of the Liver with Thoracic Involvement Presenting as an Abdominal Mass (A Very Rare Case Report): The Role of Imaging https://ejmed.org/index.php/ejmed/article/view/583 <p>Hydatid disease is common in the tropics. It is caused by infection with the larval stage of Echinococcus tapeworm. Infestation of humans, who are accidentally the intermediate host, occurs from ingestion of water or food contaminated by fecal material of definitive host (dog, wolves, deer, sheeps). The most frequent organ of involvement is the liver in up to 70%, followed by the lung about 18% and with a lower reported incidence in other organs or tissues in the body. It primarily affects the liver and shows typical imaging findings. However clinical presentation varies widely and is non specific. Thus, imaging plays an important role in diagnosis of hydatid diseases. Ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) can depict hydatid disease. The imaging methods used depend on involved organ and the radiological findings which range from purely cystic lesions to completely solid appearance. We report a very rare case of a calcified huge hydatid cyst in a 42 year old patient to buttress the role of imaging in management of such cases.</p> Mohammed Danfulani, Abubakar Musa, Ibrahim Haruna Gele, Dr Copyright (c) 2020 Mohammed Danfulani, Abubakar Musa, Ibrahim Haruna Gele, Dr http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/583 Mon, 30 Nov 2020 00:00:00 -0500 Cardiac Rehabilitation Services during COVID-19 Pandemic https://ejmed.org/index.php/ejmed/article/view/569 <p>Cardiac rehabilitation is a much appreciated but underutilized treatment strategy for cardiovascular disease. Traditional center-based cardiac rehabilitation program has been suspended due to the concrete measures adopted to flatten the COVID-19 pandemic curve. The current situation of emphasis the need of alternative approach for cardiac rehabilitation. This review shed light on consequences of COVID-19 disease on cardiac rehabilitation, the alternative approaches of cardiac rehabilitation, its potential advantages, and limitations as well as future directions.</p> Bhargav Dave, Abhishek Jagtap Copyright (c) 2020 Bhargav Dave, Abhishek Jagtap http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/569 Mon, 23 Nov 2020 04:39:42 -0500 “Don’t Distribute Free Food … Improve Our Dietary Diversification Knowledge and Skills”: Borderlanders’ Perceived Root Causes of Malnutrition in Kagera Border Region, Tanzania https://ejmed.org/index.php/ejmed/article/view/561 <p>Nutrition is a very important component for the growth and development of any society, specifically for the prevention and control of a range of diseases. In Tanzania, despite a great variability of nutrition status by different characteristics, generally the majority of the populations have poor nutrition. Kagera is among the 26 regions of mainland Tanzania with a total projected population of about 2.5 million. The nutrition status among residents is poor with multifactorial determinants. In this paper, we present qualitative data collected using in-depth interviews with key adult men and women informants in the four Tanzania-Uganda border districts. The main objective was to establish possible causes of the reported low nutrition in Kagera Region. Majority of study participants were affirmative of the availability and plenty of food; the main problem being poor dietary diversification knowledge, attitudes, skills, and practices. They recommend various measures that could improve the current nutrition status. These measures include nutrition education at primary, secondary and tertiary levels; health education at health facility level that will include nutrition topics and peer education at community level; introduction of nutrition bylaws in the community and vitalizing peer education social groups among males and females about the importance of dietary diversification. Therefore, future nutrition research should include culture, religion, and traditional indicators to inform food and nutrition interventions and policy in similar populations to the Tanzania-Uganda borderlanders.</p> Switbert R. Kamazima, Method Kazaura, Jane S. Mlimbila Copyright (c) 2020 Switbert R. Kamazima, Method Kazaura, Jane S. Mlimbila http://creativecommons.org/licenses/by/4.0 https://ejmed.org/index.php/ejmed/article/view/561 Thu, 26 Nov 2020 04:32:32 -0500