This study aimed at reviewing the management and treatment outcome, and evaluating economic burden of antiepileptic drugs (AEDs) in Ahmadu Bello University Teaching Hospital, Kaduna (ABUTH). It was a retrospective study involving use of patients’ medical records. Data retrieved from the medical records included demographics, clinic attendance, laboratory investigations, type of seizure diagnosed, effect of seizure on social life, medication use and treatment outcome. Cost of medications for patients who adhered to their therapy consistently between November 2003 and October 2004 was calculated. Data analysis was by descriptive and inferential statistics using SPSS version 16. Epilepsy had negative effects on education and marital life of patients in this study. More than half (59.3%) of the patients were diagnosed as having generalized seizure disorder. Carbamazepine was the most commonly prescribed medication (91.2%). Patients who were less than 2 years of registration in the facility had the highest percentage of those who were not regular in their clinic attendance 2 (64.7%) and low remission rate (9.8%). Chi-square analysis showed that adherence to medications had a significant effect (p 0.05) on attainment of oneyear remission. Average annual cost of AEDs was Nigerian Naira 30, 986.67 ($258.2). There was a strong correlation between clinic attendance and cost of AEDs (r = 0.454, p = 0.006) as cost of AEDs increased with increased in clinic attendance. Correlation analysis (p < 0.05, r = 0.358) also showed that cost of AEDs used by the patients reduced with increased in years since registration at this healthcare facility. Cost of AEDs did not depend on seizure type but increased with increase in clinic attendance and decreased with increase in years since registration in the healthcare facility. KEY WORDS : Epilepsy; Cost; Management; AEDs; Remission
本研究旨在回顾卡杜纳Ahmadu Bello大学教学医院(ABUTH)抗癫痫药物(aed)的管理和治疗结果，并评估其经济负担。这是一项涉及使用患者医疗记录的回顾性研究。从医疗记录中检索的数据包括人口统计数据、诊所就诊人数、实验室调查、诊断出的癫痫发作类型、癫痫发作对社会生活的影响、药物使用和治疗结果。计算了2003年11月至2004年10月期间坚持治疗的患者的药物费用。数据分析采用描述性统计和推断性统计，使用SPSS 16。在本研究中，癫痫对患者的教育和婚姻生活有负面影响。超过一半(59.3%)的患者被诊断为全身性癫痫发作障碍。卡马西平是最常用的处方药(91.2%)。在该机构注册不到2年的患者中，不定期就诊的比例最高(64.7%)，缓解率较低(9.8%)。卡方分析显示，坚持服药对达到一年缓解有显著影响(p 0.05)。aed的年平均费用为尼日利亚奈拉30986.67(258.2美元)。就诊次数与aed费用之间存在很强的相关性(r = 0.454, p = 0.006)， aed费用随着就诊次数的增加而增加。相关分析(p < 0.05, r = 0.358)还显示，自在该医疗机构登记以来，患者使用aed的费用随年份的增加而减少。抗癫痫药的费用与癫痫发作类型无关，但随着就诊人数的增加而增加，随着在医疗机构注册的年限的增加而下降。关键词:癫痫;成本;管理;aed;缓解
{"title":"Management, treatment outcome and cost of epilepsy in a tertiary health care facility in northern Nigeria","authors":"A. Ipingbemi","doi":"10.4314/IJMU.V10I2.5","DOIUrl":"https://doi.org/10.4314/IJMU.V10I2.5","url":null,"abstract":"This study aimed at reviewing the management and treatment outcome, and evaluating economic burden of antiepileptic drugs (AEDs) in Ahmadu Bello University Teaching Hospital, Kaduna (ABUTH). It was a retrospective study involving use of patients’ medical records. Data retrieved from the medical records included demographics, clinic attendance, laboratory investigations, type of seizure diagnosed, effect of seizure on social life, medication use and treatment outcome. Cost of medications for patients who adhered to their therapy consistently between November 2003 and October 2004 was calculated. Data analysis was by descriptive and inferential statistics using SPSS version 16. Epilepsy had negative effects on education and marital life of patients in this study. More than half (59.3%) of the patients were diagnosed as having generalized seizure disorder. Carbamazepine was the most commonly prescribed medication (91.2%). Patients who were less than 2 years of registration in the facility had the highest percentage of those who were not regular in their clinic attendance 2 (64.7%) and low remission rate (9.8%). Chi-square analysis showed that adherence to medications had a significant effect (p 0.05) on attainment of oneyear remission. Average annual cost of AEDs was Nigerian Naira 30, 986.67 ($258.2). There was a strong correlation between clinic attendance and cost of AEDs (r = 0.454, p = 0.006) as cost of AEDs increased with increased in clinic attendance. Correlation analysis (p < 0.05, r = 0.358) also showed that cost of AEDs used by the patients reduced with increased in years since registration at this healthcare facility. Cost of AEDs did not depend on seizure type but increased with increase in clinic attendance and decreased with increase in years since registration in the healthcare facility. KEY WORDS : Epilepsy; Cost; Management; AEDs; Remission","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"43 1","pages":"25-36"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80799291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The exercise stress test (EST) is the commonest non-invasive test to elucidate the nature of chest pain/discomfort. ST segment depression provides evidence of ischemia, but is hampered by a significant number of false negative and false positive tests. This study evaluated patterns and duration of ST depression in an attempt to differentiate false positive and false negative tests. One hundred consecutive patients with suspected angina referred to the Cardiac Clinic, who underwent an EST, and subsequently a coronary angiogram, were studied. The EST was classified as positive if significant ST depression (greater than 1mm 80msec after the J point) developed during exercise or the recovery phase. Based on the angiographic findings as the reference, the EST was classified as true positive (TP), true negative (TN), false positive (FP) or false negative (FN). Onset, magnitude and type of ST depression in relation to disease, the recovery time (RT), total ischemic time (TIT) and time-course patterns in TP versus FP results were compared by Chi square test. The EST was positive in 77 patients (true positive n = 65; false positive n = 12). The angiographic findings were classified as normal (17), non-occlusive atheroma (10) and as significant coronary stenosis in the remainder. Though the mean time to ST recovery (IRT) was shorter (183 + 118sec) in subjects with false positive compared to true positive (264 + 116sec) p<0.05, it was over three minutes and did not really help in differentiating FP from TP tests. TIT was more reliable than the IRT in delineating true positive from false positive tests. Up-sloping ST changes were more commonly associated with false positivity. Time-course patterns could not reliably distinguish TP from FP tests (TIT = 8/12, RT = 7/12), but TIT was more reliable in verifying TP (64/65) tests than IRT (59/65). KEY WORDS: Exercise stress test; ST segment time course patterns
{"title":"Clinical implications of ST segment time-course recovery patterns during the exercise stress test","authors":"D. Naidoo","doi":"10.4314/IJMU.V10I2.2","DOIUrl":"https://doi.org/10.4314/IJMU.V10I2.2","url":null,"abstract":"The exercise stress test (EST) is the commonest non-invasive test to elucidate the nature of chest pain/discomfort. ST segment depression provides evidence of ischemia, but is hampered by a significant number of false negative and false positive tests. This study evaluated patterns and duration of ST depression in an attempt to differentiate false positive and false negative tests. One hundred consecutive patients with suspected angina referred to the Cardiac Clinic, who underwent an EST, and subsequently a coronary angiogram, were studied. The EST was classified as positive if significant ST depression (greater than 1mm 80msec after the J point) developed during exercise or the recovery phase. Based on the angiographic findings as the reference, the EST was classified as true positive (TP), true negative (TN), false positive (FP) or false negative (FN). Onset, magnitude and type of ST depression in relation to disease, the recovery time (RT), total ischemic time (TIT) and time-course patterns in TP versus FP results were compared by Chi square test. The EST was positive in 77 patients (true positive n = 65; false positive n = 12). The angiographic findings were classified as normal (17), non-occlusive atheroma (10) and as significant coronary stenosis in the remainder. Though the mean time to ST recovery (IRT) was shorter (183 + 118sec) in subjects with false positive compared to true positive (264 + 116sec) p<0.05, it was over three minutes and did not really help in differentiating FP from TP tests. TIT was more reliable than the IRT in delineating true positive from false positive tests. Up-sloping ST changes were more commonly associated with false positivity. Time-course patterns could not reliably distinguish TP from FP tests (TIT = 8/12, RT = 7/12), but TIT was more reliable in verifying TP (64/65) tests than IRT (59/65). KEY WORDS: Exercise stress test; ST segment time course patterns","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"39 1","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87984327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alcohol dependence is a chronic, debilitating disorder that is an important public health problem worldwide. Combined psychological and pharmacological treatment packages produce best outcomes in its management. In this paper we discuss the three NICE – approved relapse prevention medications used in treatment of alcohol dependence: acamprosate, naltrexone and disulfiram. We review the pharmacological profile, mode of action, pharmacokinetics, and safety and tolerability of each of these pharmacological interventions. We discuss how each intervention can be used in clinical practice and review the efficacy of each drug. No one drug is clearly superior to the other, and clinical factors and patient choice should inform the choice of drug. KEY WORDS : Alcohol; Dependence; Pharmacological treatment
{"title":"Pharmacological interventions for alcohol relapse prevention","authors":"Anita Chithiramohan, Sanju George","doi":"10.4314/IJMU.V10I2.7","DOIUrl":"https://doi.org/10.4314/IJMU.V10I2.7","url":null,"abstract":"Alcohol dependence is a chronic, debilitating disorder that is an important public health problem worldwide. Combined psychological and pharmacological treatment packages produce best outcomes in its management. In this paper we discuss the three NICE – approved relapse prevention medications used in treatment of alcohol dependence: acamprosate, naltrexone and disulfiram. We review the pharmacological profile, mode of action, pharmacokinetics, and safety and tolerability of each of these pharmacological interventions. We discuss how each intervention can be used in clinical practice and review the efficacy of each drug. No one drug is clearly superior to the other, and clinical factors and patient choice should inform the choice of drug. KEY WORDS : Alcohol; Dependence; Pharmacological treatment","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"6 1","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85581440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Different studies show different attitudes towards mental illness among medical students. This study was initiated to explore the attitude towards mental illness among medical students in a medical college of Manipur. A cross-sectional selfadministered questionnaire-based study was conducted among medical students in Manipur. Two self rating scales – Social Distance Scale and Dangerousness scale were used to assess attitude towards mental illness. Descriptive statistics and independent sample t-test were applied using SPSS 22 for analysis. The students didn’t keep social distance against the mentally ill, and exposure to psychiatry did not have any effect. However regarding dangerousness scale they had a negative attitude towards mental illness and as overall exposure to psychiatry did not have any effect. Medical students did not keep social distance against the mentally ill, however these students have tendency to feel that mentally ill persons are dangerous. KEY WORDS : Attitudes; Mental illness; Likert scale; Psychiatry
{"title":"Study on the attitude of “Tomorrow’s Doctors” towards mental illness: A cross-sectional study","authors":"H. Singh, T. Singh, Y. Singh","doi":"10.4314/IJMU.V10I2.4","DOIUrl":"https://doi.org/10.4314/IJMU.V10I2.4","url":null,"abstract":"Different studies show different attitudes towards mental illness among medical students. This study was initiated to explore the attitude towards mental illness among medical students in a medical college of Manipur. A cross-sectional selfadministered questionnaire-based study was conducted among medical students in Manipur. Two self rating scales – Social Distance Scale and Dangerousness scale were used to assess attitude towards mental illness. Descriptive statistics and independent sample t-test were applied using SPSS 22 for analysis. The students didn’t keep social distance against the mentally ill, and exposure to psychiatry did not have any effect. However regarding dangerousness scale they had a negative attitude towards mental illness and as overall exposure to psychiatry did not have any effect. Medical students did not keep social distance against the mentally ill, however these students have tendency to feel that mentally ill persons are dangerous. KEY WORDS : Attitudes; Mental illness; Likert scale; Psychiatry","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"22 1","pages":"20-24"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87549800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caring for those addicted to drugs and/or alcohol can adversely affect carers and this can manifest as stress, anxiety, depression, insomnia, substance misuse and a range of physical health problems. In most health care settings, be it primary care or secondary care, more often than not carers’ needs go undetected and hence untreated. In the case report below we illustrate how weekly yoga classes helped a carer (of an addict) cope better. In light of the numerous benefits of yoga to carers of addicts (as described below) we call on drug and alcohol services to incorporate this simple and inexpensive intervention into their treatment programmes. KEY WORDS : Yoga; Carers; Drug addiction
{"title":"Yoga for carers of addicted patients: a carer's self-report","authors":"A. George, D. Amory-Reid","doi":"10.4314/IJMU.V10I1.5","DOIUrl":"https://doi.org/10.4314/IJMU.V10I1.5","url":null,"abstract":"Caring for those addicted to drugs and/or alcohol can adversely affect carers and this can manifest as stress, anxiety, depression, insomnia, substance misuse and a range of physical health problems. In most health care settings, be it primary care or secondary care, more often than not carers’ needs go undetected and hence untreated. In the case report below we illustrate how weekly yoga classes helped a carer (of an addict) cope better. In light of the numerous benefits of yoga to carers of addicts (as described below) we call on drug and alcohol services to incorporate this simple and inexpensive intervention into their treatment programmes. KEY WORDS : Yoga; Carers; Drug addiction","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"131 1","pages":"26-28"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76415352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to analyze the clinical signs of diagnosis, treatment and followup of the pediatric population presenting with acute compartment syndrome in the emergency room at an Institutional Level II trauma center. The study is a prospective case series. Thirty-two samples were selected from Institutional Trauma Centre, King George’s Medical University, Lucknow, between January 2005 and December 2010. Children presenting with clinically suspected acute compartment syndrome were studied. These were divided into two age related groups: Group A (children to 18 years) comprised of 20 children. Patients’ demographics, diagnosis, treatment, follow-up and complications were analyzed. Acute compartment syndrome represents a surgical emergency. The clinical signs predict and corroborate with acute increases in compartment pressure effectively. KEY WORDS: Acute compartment syndrome; Raised compartment pressure; Acute compartment syndrome in children; Acute compartment syndrome and fasciotomy
{"title":"Evaluation of acute compartment syndrome of extremities in emergency room: a case series of 32 children","authors":"A. Singh, Sabir Ali, R. Srivastava","doi":"10.4314/IJMU.V10I2.6","DOIUrl":"https://doi.org/10.4314/IJMU.V10I2.6","url":null,"abstract":"The aim of this study was to analyze the clinical signs of diagnosis, treatment and followup of the pediatric population presenting with acute compartment syndrome in the emergency room at an Institutional Level II trauma center. The study is a prospective case series. Thirty-two samples were selected from Institutional Trauma Centre, King George’s Medical University, Lucknow, between January 2005 and December 2010. Children presenting with clinically suspected acute compartment syndrome were studied. These were divided into two age related groups: Group A (children to 18 years) comprised of 20 children. Patients’ demographics, diagnosis, treatment, follow-up and complications were analyzed. Acute compartment syndrome represents a surgical emergency. The clinical signs predict and corroborate with acute increases in compartment pressure effectively. KEY WORDS: Acute compartment syndrome; Raised compartment pressure; Acute compartment syndrome in children; Acute compartment syndrome and fasciotomy","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"41 1","pages":"37-40"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85538177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Sethi, Sunil Kumar, K. Butola, J. Mishra, Yogesh Kumar
Although blood transfusion is a life-saving maneuver, it is associated with certain risks. In general, transfusion-related adverse events are categorized as infectious and noninfectious. Transfusion-transmissible infectious agents such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for the recipient. To assess the magnitude and dynamics of disease transmission and for its prevention and control, the study of its seroprevalence is important. Our institute, catering to the needs of a large population in the foothills of the Himalayas, represents an important center for serological surveys. This study aimed to determine the seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors in a tertiary care center of this region. A retrospective analysis of medical records of blood donors who met the standard criteria for donor fitness were screened for HIV, HBS, HCV, Syphilis and Malaria, from January 2007 to December 2011 (5 years). Out of 7884 units collected, 83 (1.05%) units had seropositivity for HBsAg/anti-HCV Ab/anti-HIV Ab/anti-Treponemal Ab, 2 units each revealed dual infections with HIV-HBV and HIV-HCV. Seropositivity rates of HBsAg, anti-HCV Ab, anti-HIV Ab and anti-treponemal Ab were 0.63%, 0.20%, 0.19% and 0.02%, respectively. Even with the implementation of effective preventive strategies, there is significant risk of transmission of infectious agents in India. Efforts to ensure an adequate and safe blood supply should include proper screening and striving for optimal use of blood and its products. Keywords : Seroprevalence; HIV; Hepatitis B; Hepatitis C; Syphilis; Uttarakhand
{"title":"Seroprevalence pattern among blood donors in a tertiary health care center","authors":"B. Sethi, Sunil Kumar, K. Butola, J. Mishra, Yogesh Kumar","doi":"10.4314/IJMU.V9I1","DOIUrl":"https://doi.org/10.4314/IJMU.V9I1","url":null,"abstract":"Although blood transfusion is a life-saving maneuver, it is associated with certain risks. In general, transfusion-related adverse events are categorized as infectious and noninfectious. Transfusion-transmissible infectious agents such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for the recipient. To assess the magnitude and dynamics of disease transmission and for its prevention and control, the study of its seroprevalence is important. Our institute, catering to the needs of a large population in the foothills of the Himalayas, represents an important center for serological surveys. This study aimed to determine the seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors in a tertiary care center of this region. A retrospective analysis of medical records of blood donors who met the standard criteria for donor fitness were screened for HIV, HBS, HCV, Syphilis and Malaria, from January 2007 to December 2011 (5 years). Out of 7884 units collected, 83 (1.05%) units had seropositivity for HBsAg/anti-HCV Ab/anti-HIV Ab/anti-Treponemal Ab, 2 units each revealed dual infections with HIV-HBV and HIV-HCV. Seropositivity rates of HBsAg, anti-HCV Ab, anti-HIV Ab and anti-treponemal Ab were 0.63%, 0.20%, 0.19% and 0.02%, respectively. Even with the implementation of effective preventive strategies, there is significant risk of transmission of infectious agents in India. Efforts to ensure an adequate and safe blood supply should include proper screening and striving for optimal use of blood and its products. Keywords : Seroprevalence; HIV; Hepatitis B; Hepatitis C; Syphilis; Uttarakhand","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"28 1","pages":"10-15"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80264701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Glycogen storage disease (GSD) type 3 is an inborn error of glycogen metabolism resulting from the deficient activity of glycogen debranching enzyme. It is associated with progressive liver disease, myopathy and risk of cardiomyopathy with an incidence of 1 in 100000 live births. We describe a successful pregnancy outcome in a woman with GSD type 3 with an emphasis on the risk of peripartum cardiopulmonary complication. A 34-year-old primigravida with known GSD type 3 was booked at 8 weeks. She was diagnosed with GSD type 3 in childhood and developed progressive skeletal myopathy, hypertrophic cardiomyopathy and liver cirrhosis in adolescent years. She developed liver failure at age 30 and underwent a successful liver transplant a year later. Antenatally she remained on tacrolimus 2 mg twice daily and her liver function tests remained normal. Serial echocardiogram did not reveal any evidence of deterioration of the previously diagnosed left ventricular hypertrophic cardiomyopathy and she had no symptoms suggestive of cardiac decompensation. Fetal wellbeing was satisfactory with a normal anatomy scan and good growth velocities on serial scans. A multidisciplinary review at 34 weeks agreed on a planned delivery by elective caesarean section at 37 weeks with the aim of avoiding spontaneous onset of labor. This was based on the unpredictability of labor with associated tachycardia which, coupled with her underlying diastolic dysfunction, could precipitate pulmonary congestion. An earlier gestation of 37 weeks was chosen in view of her history of liver transplant, which carries a risk of spontaneous preterm labor. An elective caesarean section was performed in cardiac theatre at 37 weeks under GA with continuous cardiac monitoring, a CVP, arterial line and transesophageal echocardiogram in place. A live baby boy weight 3130 gm was delivered in very good condition. The procedure was surgically uncomplicated with a blood loss of 350 ml. However, just after the delivery, she developed acute pulmonary oedema. She received intravenous frusemide and remained in the cardiac intensive care unit where she made good recovery and was transferred to the postnatal ward within 48 hours, prior to her hospital discharge on postnatal day 4. Existing literature on pregnancy in women with GSD type 3 mainly involved pre-transplant patients and focused on antenatal prevention of hypoglycaemia with frequent cornflour supplements. The risk of peripartum cardiopulmonary complication has not been highlighted in seemingly stable patients. The susceptibility to hypoglycaemia is not a concern in post liver transplant patients. The acute pulmonary oedema developed by our patient, with the benefit of invasive monitoring and meticulous fluid management, is believed to have been induced by the transient increase in intravascular volume caused by ‘uterine autotransfusion’ following uterine contraction after delivery of the baby. This physiologic process is usually unnoticeable in hea
{"title":"Glycogen storage disease type 3: A management challenge in pregnancy","authors":"Og Okunoye, C. Deakin, S. Maguire","doi":"10.4314/IJMU.V9I2","DOIUrl":"https://doi.org/10.4314/IJMU.V9I2","url":null,"abstract":"Glycogen storage disease (GSD) type 3 is an inborn error of glycogen metabolism resulting from the deficient activity of glycogen debranching enzyme. It is associated with progressive liver disease, myopathy and risk of cardiomyopathy with an incidence of 1 in 100000 live births. We describe a successful pregnancy outcome in a woman with GSD type 3 with an emphasis on the risk of peripartum cardiopulmonary complication. A 34-year-old primigravida with known GSD type 3 was booked at 8 weeks. She was diagnosed with GSD type 3 in childhood and developed progressive skeletal myopathy, hypertrophic cardiomyopathy and liver cirrhosis in adolescent years. She developed liver failure at age 30 and underwent a successful liver transplant a year later. Antenatally she remained on tacrolimus 2 mg twice daily and her liver function tests remained normal. Serial echocardiogram did not reveal any evidence of deterioration of the previously diagnosed left ventricular hypertrophic cardiomyopathy and she had no symptoms suggestive of cardiac decompensation. Fetal wellbeing was satisfactory with a normal anatomy scan and good growth velocities on serial scans. A multidisciplinary review at 34 weeks agreed on a planned delivery by elective caesarean section at 37 weeks with the aim of avoiding spontaneous onset of labor. This was based on the unpredictability of labor with associated tachycardia which, coupled with her underlying diastolic dysfunction, could precipitate pulmonary congestion. An earlier gestation of 37 weeks was chosen in view of her history of liver transplant, which carries a risk of spontaneous preterm labor. An elective caesarean section was performed in cardiac theatre at 37 weeks under GA with continuous cardiac monitoring, a CVP, arterial line and transesophageal echocardiogram in place. A live baby boy weight 3130 gm was delivered in very good condition. The procedure was surgically uncomplicated with a blood loss of 350 ml. However, just after the delivery, she developed acute pulmonary oedema. She received intravenous frusemide and remained in the cardiac intensive care unit where she made good recovery and was transferred to the postnatal ward within 48 hours, prior to her hospital discharge on postnatal day 4. Existing literature on pregnancy in women with GSD type 3 mainly involved pre-transplant patients and focused on antenatal prevention of hypoglycaemia with frequent cornflour supplements. The risk of peripartum cardiopulmonary complication has not been highlighted in seemingly stable patients. The susceptibility to hypoglycaemia is not a concern in post liver transplant patients. The acute pulmonary oedema developed by our patient, with the benefit of invasive monitoring and meticulous fluid management, is believed to have been induced by the transient increase in intravascular volume caused by ‘uterine autotransfusion’ following uterine contraction after delivery of the baby. This physiologic process is usually unnoticeable in hea","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"72 1","pages":"28-28"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76084147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A versatile assessment technique used in classroom for quick and simple feedback is ‘One-Minute paper’. It provides real-time feedback from class and enables the teacher to find out if students have recognized the main points in a class session. The objectives of the study were to employ one-minute paper for post-graduate students during a continuous medical education (CME) program lecture, to assess its effectiveness for achievement of objectives and learning ability of the students, to analyze the questioning pattern of the students for the topic and to obtain feedback on participant’s perception on use of ‘one-minute paper’. The study was employed for one-hour lecture in CME program for post-graduate students. One-Minute paper was employed for the topic ‘Phenylketonuria’. The lecture was sub-divided into five components and the response sheet was designed accordingly. The delivery time for each component varied between 8 to 12 minutes. At the end of each component, 2 minutes was given for the participants to respond to two questions - what was the most important thing they learnt during this session and what important question remains unanswered? Analysis of response was carried out to know achievement of objectives, association of learning ability and questioning pattern. Response to the learning ability showed that 80 to 90% of the participants responded satisfactorily to all the components. Questioning pattern was least for component 3 of the lecture. Questioning skills showed that most questions were in stage 1, 4 and 5. Participants reflected that the use of ‘one-minute paper’ was thinking centered, engaged them throughout the topic and provided liberty for them to ask questions. One-minute paper is inexpensive, easy to use, and an instant assessment means, which reflects the achievement of learning objectives. It is a thinking centered assessment tool, which gives ample opportunity to the learner for active learning. Keywords : One-Minute paper; Questioning pattern; Questioning skills; Thinking centered
{"title":"One-Minute Paper: A thinking centered assessment tool","authors":"S. Ashakiran, R. Deepthi","doi":"10.4314/IJMU.V8I2","DOIUrl":"https://doi.org/10.4314/IJMU.V8I2","url":null,"abstract":"A versatile assessment technique used in classroom for quick and simple feedback is ‘One-Minute paper’. It provides real-time feedback from class and enables the teacher to find out if students have recognized the main points in a class session. The objectives of the study were to employ one-minute paper for post-graduate students during a continuous medical education (CME) program lecture, to assess its effectiveness for achievement of objectives and learning ability of the students, to analyze the questioning pattern of the students for the topic and to obtain feedback on participant’s perception on use of ‘one-minute paper’. The study was employed for one-hour lecture in CME program for post-graduate students. One-Minute paper was employed for the topic ‘Phenylketonuria’. The lecture was sub-divided into five components and the response sheet was designed accordingly. The delivery time for each component varied between 8 to 12 minutes. At the end of each component, 2 minutes was given for the participants to respond to two questions - what was the most important thing they learnt during this session and what important question remains unanswered? Analysis of response was carried out to know achievement of objectives, association of learning ability and questioning pattern. Response to the learning ability showed that 80 to 90% of the participants responded satisfactorily to all the components. Questioning pattern was least for component 3 of the lecture. Questioning skills showed that most questions were in stage 1, 4 and 5. Participants reflected that the use of ‘one-minute paper’ was thinking centered, engaged them throughout the topic and provided liberty for them to ask questions. One-minute paper is inexpensive, easy to use, and an instant assessment means, which reflects the achievement of learning objectives. It is a thinking centered assessment tool, which gives ample opportunity to the learner for active learning. Keywords : One-Minute paper; Questioning pattern; Questioning skills; Thinking centered","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"21 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2013-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75045355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT: A 37-year old male presented to us with history of lower abdominal pain for 6 months. His physical examination revealed a rectal mass of approximately 1centimeter. He was investigated for possible rectal growth with sigmoidoscopy and biopsy. The histopathological examination (HPE) showed a non-specific chronic inflammation in the tissue from the mass. Another tissue from the mass was sent for polymerase chain reaction (PCR) for tuberculosis, which turned out to be positive. The patient was started on standard anti tubercular (ATT) regimen and responded completely to the treatment. We discuss the patient and review some of the available literature on the topic and discuss the issue of considering a diagnosis of tuberculosis in cases with rectal mass specially when it has become a major public health issue with increasing number of HIV (Human Immunodeficiency Virus) infected patients. Keywords : Rectal TB; Tuberculosis; Rectal Growth Internet Journal of Medical Update . 2013 January;8(1):42-44
{"title":"Masquerading Mycobacterium: Rectal Growth or Tuberculosis?","authors":"N. Choudhury, Sumitra Hagjer","doi":"10.4314/IJMU.V8I1","DOIUrl":"https://doi.org/10.4314/IJMU.V8I1","url":null,"abstract":"ABSTRACT: A 37-year old male presented to us with history of lower abdominal pain for 6 months. His physical examination revealed a rectal mass of approximately 1centimeter. He was investigated for possible rectal growth with sigmoidoscopy and biopsy. The histopathological examination (HPE) showed a non-specific chronic inflammation in the tissue from the mass. Another tissue from the mass was sent for polymerase chain reaction (PCR) for tuberculosis, which turned out to be positive. The patient was started on standard anti tubercular (ATT) regimen and responded completely to the treatment. We discuss the patient and review some of the available literature on the topic and discuss the issue of considering a diagnosis of tuberculosis in cases with rectal mass specially when it has become a major public health issue with increasing number of HIV (Human Immunodeficiency Virus) infected patients. Keywords : Rectal TB; Tuberculosis; Rectal Growth Internet Journal of Medical Update . 2013 January;8(1):42-44","PeriodicalId":14472,"journal":{"name":"Internet Journal of Medical Update - EJOURNAL","volume":"14 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72892256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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