Annals of Medical Research and Practice
EISSN : 2672-4715
Published by: Scientific Scholar (10.25259)
Total articles ≅ 23
Latest articles in this journal
Annals of Medical Research and Practice, Volume 3; https://doi.org/10.25259/anmrp_24_2021
Objectives: Pleural effusion is one of the common presentations of several several diseases in clinical practice. The pathology behind a pleural effusion is often not clear on pleural fluid analysis. In developing countries like India, empirical antitubercular treatment is started assuming exudative pleural effusion to be tuberculosis. Over some time with more emphasis on evidence-based medicine, this is not a right approach. Thoracoscopic examination and biopsy visceral are a minimally invasive procedure which is underutilized in our practice. The study was conducted to evaluate the definitive etiological diagnosis of exudative pleural effusion and to analyze the diagnostic yield of thoracoscopic biopsy in the diagnosis of exudative pleural effusion. Material and Methods: The study was conducted in the Department of Medicine and Oncology, Command Hospital Airforce, Bengaluru, India. All adult patients with exudative pleural effusion (according to light’s criteria) reporting to the hospital from January 2019 to December 2020 were included and subjected for analysis. Results: Out of a total of 100 patients who were included in the study, there was male predominance with 78 males and 22 females. Thoracoscopic biopsy remained conclusive in 100% of cases. Malignancy was the most common etiology with 48% of cases while tuberculosis was seen in 38%, 12% had inflammation, and 2 (02%) had mucormycosis. TB PCR sensitivity and specificity of TB PCR were 42% and 100%, respectively. MTB culture showed sensitivity of 11%. MTB culture of biopsy showed sensitivity of 26%. The specificity in both the methods was 100%. Conclusion: Thoracoscopy is an ideal method for the diagnosis of pleural effusion with suspected exudative pathology. It gives an accurate diagnosis and helps differentiate between tuberculosis and malignancy which are the most common etiologies in India, thereby leading to early appropriate and specific treatment in such patients. Malignancy was the most common etiology in our study.
Annals of Medical Research and Practice, Volume 3; https://doi.org/10.25259/anmrp_16_2021
This review aims to evaluate whether retrograde intrarenal surgery (RIRS) is a safe and efficient alternative treatment to percutaneous nephrolithotomy (PCNL) for stones 20 mm or greater in terms of stone-free rate (SFR) and shorter hospital stay due to lower complications. Research conducted in the years 2007–2017 was considered relevant. Numerous search engines were used to acquire the eight papers included in this meta-analysis. From the eight key papers that were considered, one was a meta-analysis, one was a prospective clinical controlled trial (CCT), and the other six were retrospective CCTs. All studies found higher SFRs in PCNL but the difference was statistically significant in only two of the included studies. This improvement was not reported in any of the studies, including the meta-analysis. As a result, this reflects an inconsistency in the evidence produced. When evaluating hospital stay, all researchers found a statistically significantly shorter stay in the RIRS group compared to the PCNL group, this being potentially attributed to higher rates in minor complications. Due to the inconsistencies evaluated from the key papers, it was concluded that study results ought to be interpreted with caution. RIRS seems to be a safe and effective surgical procedure for selected patients as RIRS offers a comparable initial SFR success as PCNL. This is a cautious statement, drawn in view of inconsistent evidence regarding its superiority over PCNL in this regard. Furthermore, consistent evidence is available, demonstrating its ability to significantly reduce hospital stay without increasing complications. Therefore, RIRS may be considered an alternative to PCNL in selected patients. With that being said, more research is required on this evaluation given that a definite conclusion cannot be reached.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_23_2021
Gunshot injuries among children are a major clinical and public health concern and one of the leading causes of pediatric morbidity and mortality. This usually takes a great financial and emotional toll on the affected children, their families, and society as a whole. The objective of the study was to determine the pattern of injury, severity, outcome, and challenges in managing the gunshot injuries in children. This is a descriptive study of patients below 18 years of age who presented with gunshot injuries to the Jos University Teaching Hospital between January 2011 and December 2014. Patient demographics and clinical details were collected on a trauma data sheet, and entered into an Excel spreadsheet. It was analyzed descriptively. Two hundred and forty-two patients presented with gunshot injuries in the period under review, of which 30 of them were children. The median age of the patients was 12 years with an interquartile range of 7.75 and 16.25. Twenty-two (73.3%) of them were male while 8 (26.7%) were female. High-velocity firearms accounted for 13 (43.3%) of the injuries and were the most predominant cause of injury. The most common part of the body involved was the extremities in 63.3% of patients. Debridement and secondary suturing was carried out in 83.3% of the patients while wound infection was the most noted complication in 33.3% of the patients. There is an increasing incidence of gunshot injuries in this region. A lot of the children survive and reach the hospital though, and most of them are treated and discharged, however, attendant emotional and psychological trauma cannot be excluded in these patients. There is, thus, a need for proper policy to protect and treat these children when this happens.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_17_2021
Birth defects are universal problems associated with poor management outcomes in children, especially in developing countries where its burden is enormous. Media advocacy is believed to help in reducing these poor outcomes. This study assessed the level of awareness of birth defects in women and the impact of the media in Nigeria. This was a descriptive cross-sectional study of 778 women, conducted in the outpatient clinics of two major referral hospitals in Ibadan, Nigeria, from March to October 2019. Of the 778 women, 768 were administered a structured questionnaire and 10 women whose children have been managed for a congenital anomaly before were interviewed using an in-depth interview guide. Of the 768 respondents, 600 (78.1%) were in the third and fourth decades of life and 577 (75.1%) women have heard about birth defects before. A total of 348 (60.3%) and 134 (23.2%) women heard about it from the hospital and mass media, respectively, with 65.0% of them believing that the media were helping in educating people about birth defects. There was a statistically significant relationship between the awareness levels and the respondents’ occupation (χ2 = 28.914, P< 0.001), educational status (χ2=43.325, P< 0.001), religion (χ2 = 10.376, P = 0.016), antenatal clinic attendance (χ2 = 5.035, P = 0.025), and history of previous mid-trimester abortion (χ2 = 7.689, P = 0.006). The level of awareness about birth defects is good but not enough; there is a need for greater media involvement in disseminating information on the occurrence of birth defects.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_8_2021
Objectives: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. Material and Methods: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). Results: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. Conclusion: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_18_2021
Objectives: Infection prevention and control (IPC) practice in health facility (HF) is abysmally low in developing countries, resulting in significant preventable morbidity and mortality. This study assessed and compared health workers’ (HWs) practice of IPC strategies in public and private secondary HFs in Kaduna State. Material and Methods: A cross-sectional comparative study was employed. Using multistage sampling, 227 participants each were selected comprising of doctors, midwives, and nurses from public and private HF. Data were collected using interviewer-administered questionnaire and observation checklist and analyzed using bivariate and multivariate analysis. Statistical significance determined at P < 0.05. Results: The practice of infection prevention was poor. Overall, 42.3% of the HWs did not change their gowns in-between patients, with the significantly higher rates in 73.1% of private compared to 42.3% of public HF workers (P < 0.001). In addition, 30.5% and 10.1% of HWs do not use face mask and eye goggle, respectively, when conducting procedures likely to generate splash of body fluids, however, there was no significant difference in these poor practices in public compared to private HFs. The mean IPC practice was 51.6 ± 12.5%, this was significantly lower among public (48.8 ± 12.5%) compared to private (54.5 ± 11.9%) HF workers (P < 0.0001). Private HF workers were 3 times more likely to implement IPC interventions compared to public HF workers. Conclusion: IPC practice especially among public HF workers was poor.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_15_2021
Lassa fever (LF) coinfection with hepatitis B and HIV has been reported among hospitalized patients in Southwest Nigeria and HIV patients coinfected with COVID-19 have been described among hospitalized patients in North Central Nigeria, no study has reported cases of coinfection of Lassa disease and COVID-19 among health care workers (HCWs) worldwide. A case report of two HCWs who were infected with both LF virus and SARS-CoV-2 virus at same time and were successfully managed without any sequelae. Both cases presented with typical signs of LF with COVID-19 suspected, they were promptly diagnosezd with positive outcomes after treatment. While case 1 became negative for LF virus and SARS-CoV-2 after 6 and 30 days, respectively, case 2 became negative for both viruses after 14 and 32 days, respectively. The diagnosis of LF-COVID-19 coinfection in HCWs is a frightening dimension to the health risks faced by HCWs, therefore, HCWs now more than ever before want to know what comes next and how safe is the practice of medicine.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_10_2021
Objectives: Prostate cancer is the most common cancer affecting men in Nigeria. Trans-rectal ultrasound-guided biopsy of the prostate is routinely performed to diagnose prostate cancer. Though safe, prostate biopsy may be associated with some complications. In Nigeria, there are scanty national guidelines on prophylactic measures and techniques in prostate biopsy. The aim of the study was to assess the pre-biopsy prophylactic measures and biopsy protocols employed by Nigerian Urologists. Material and Methods: A survey questionnaire was distributed during the 2019 Annual General Meeting of the Nigerian Association of Urologic Surgeons and information collected on the biopsy route, use of anesthesia, antibiotic prophylaxis, number of samples taken, and possible complications. Results: A total of 72 urologists participated in the study. Bowel preparation was performed by 10 (13.9%) participants for a duration of 1–3 days. All urologists used the transrectal route and anesthesia was given by all. Prophylactic antibiotics were given by all participants. Our participants administered antibiotic prophylaxis for a period of 1, 3, 5, or 7 days (4.2%, 23.6%, 43.1%, and 22.2%, respectively). Ciprofloxacin/metronidazole combination was most commonly prescribed (70.8%). Most urologists (69.4%) commonly take between 8 and 12 core tissues per biopsy session. The most common complication was hemorrhage (43.1%), followed by perineal pain (40.3%). Conclusion: There is a lack of evenness in pre-biopsy prophylactic measures and biopsy protocol among Nigerian Urologists. There is a need for a Nigerian guideline to elucidate the most appropriate antibiotic(s), route of administration and duration of treatment, the preferred anesthesia type, and the number of core-tissues that are appropriate.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_6_2021
Objectives: Testicular torsion is the twisting of the spermatic cord with attendant loss of the blood supply to the affected testis. It is a common urological emergency and one of the frequent causes of acute scrotum in adolescents and young adults. Prompt diagnosis and immediate surgical intervention are necessary for testicular salvage. Testicular loss is directly linked to delay in presentation, surgery, and the referral patterns at the point of the first contact with health-care providers. The purpose of our study is to assess the knowledge, management methods, and referral pattern among health care workers in the primary health-care facilities in Auchi primary health-care zone, Nigeria. Material and Methods: This was a cross-sectional carried out among primary health care workers in Auchi primary health-care zone between May and October 2020. A structured self-administered questionnaire was given to all the first contact health care workers in this zone. The knowledge, management, and referral pattern of testicular torsion were determined based on responses to the questionnaires. Data were analyzed using SPSS version 21. Results were displayed with frequency distribution tables and charts. Results: Eighty-seven health care workers met the inclusion criteria and were given questionnaires to fill. The mean age of the respondents was 37.74 ± 7.53 years. The majority of the health workers (n = 66, 75.9%) have more than 5 years’ experience with only 12 (13.8%) having a secondary level of education. Most respondents have heard of testicular torsion (n = 77, 88.5%) and know the symptoms (n = 68, 78.2%) but they have a poor knowledge of the age group predominantly affected (n = 36, 41.1%) and testicular survival time following torsion (n= 41, 47.7%). Only about a third (n = 28, 32.2%) had attended to patients with testicular torsion. Of the 28 health workers who had managed patients with testicular torsion, less than half (n = 11, 39.3%) referred almost immediately, while about half treated conservatively (n = 14, 49.9%) keeping the patients under their care for a period of 3–7 days. Conclusion: This study showed that a comprehensive education of all categories of health workers in the primary health-care centers is needed. This is necessary for the early identification and appropriate surgical intervention or prompt referral of patients with testicular torsion to prevent avoidable testicular losses.
Annals of Medical Research and Practice, Volume 2; https://doi.org/10.25259/anmrp_4_2021
Objectives: The COVID-19 pandemic has created significant psychological challenges globally. Evidence has been mounting of greater emotional distress and possible worsening of underlying psychiatric disorders, due to repercussions of COVID-19. In addition, the pandemic has created barriers to access for help, due to social distancing and travel restrictions. Thus, creating a major need for effective interventions that can be accessed safely from home and provide coping tools which can be learned and practiced while in isolation. An App based Yoga of Immortals (YOI) program is one such strategy to help cope with stressful situations. The objective of this study was to investigate if the YOI program can provide significant benefit for depressive and insomnia symptoms. Material and Methods: Participants in this study were asked to complete two brief online but well validated mental health screening tools before intervention. This was followed by a 7-week long YOI intervention. Following the intervention, participants were once again asked to complete the online validated questionnaires. The survey questionnaires included baseline demographic data and validated scales for measuring insomnia severity Insomnia severity Index (ISI) and levels of depression symptoms patient health questionnaire-8, (PHQ-8). All statistical analysis was performed using the Statistical Package for the Social Science. Results: SY YOI intervention of 7 weeks significantly improved the ISI scores as well as PHQ-8 scores in the study population (P < 0.0001 in all comparisons). Conclusion: YOI intervention is an effective intervention strategy for decreasing insomnia and depression symptoms, even during the pandemic.