Pub Date : 2019-06-29DOI: 10.3329/IMCJMS.V13I1.42049
T. Haq, F. Ong, S. Kanji
Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue. IMC J Med Sci 2019; 13(1): 002
{"title":"Brown Adipose Tissue - role in metabolic disorders","authors":"T. Haq, F. Ong, S. Kanji","doi":"10.3329/IMCJMS.V13I1.42049","DOIUrl":"https://doi.org/10.3329/IMCJMS.V13I1.42049","url":null,"abstract":"Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue. \u0000IMC J Med Sci 2019; 13(1): 002","PeriodicalId":55816,"journal":{"name":"IMC Journal of Medical Science","volume":"160 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73796717","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}
Pub Date : 2019-06-29DOI: 10.3329/IMCJMS.V13I1.42041
A. Faruq, H. Raihan, Muhtarima Haque
Background and objectives: Mesh infection following hernia repair has previously often resulted in removal of mesh. The aim of this study was to evaluate if negative pressure wound therapy (NPWT) can be used to treat such complications and preserve the mesh. Materials and method: A prospective study was carried in the Department of Surgery, BIRDEM General Hospital from January 2017 to January 2019. Patients with deep wound infection and exposed infected mesh after hernioplasty were included in the study. Patients’ demographics, existing comorbidities and outcome were recorded. All patients were treated with NPWT till the wound was covered with healthy granulation tissue and closed. Results: NPWT was used to treat 7 patients with mesh infection following hernia repair. There was 2 male and 5 female cases and age ranged from 38-58 years. With NPWT the mesh in 6 patients (86%) out of 7 could be completely salvaged and wound closed with secondary suturing. However, in 1 patient although the mesh covered with granulation tissue by NPWT and wound was closed; but it had to be partly removed later on due to development of chronic discharging sinus 20 days after stitch removal. Conclusion: The study demonstrated that NPWT was a useful technique for the treatment and preservation of infected mesh after hernia repair. IMC J Med Sci 2019; 13(1): 008
{"title":"Management of non-absorbable mesh infection after hernia repair by negative pressure wound therapy","authors":"A. Faruq, H. Raihan, Muhtarima Haque","doi":"10.3329/IMCJMS.V13I1.42041","DOIUrl":"https://doi.org/10.3329/IMCJMS.V13I1.42041","url":null,"abstract":"Background and objectives: Mesh infection following hernia repair has previously often resulted in removal of mesh. The aim of this study was to evaluate if negative pressure wound therapy (NPWT) can be used to treat such complications and preserve the mesh. \u0000Materials and method: A prospective study was carried in the Department of Surgery, BIRDEM General Hospital from January 2017 to January 2019. Patients with deep wound infection and exposed infected mesh after hernioplasty were included in the study. Patients’ demographics, existing comorbidities and outcome were recorded. All patients were treated with NPWT till the wound was covered with healthy granulation tissue and closed. \u0000Results: NPWT was used to treat 7 patients with mesh infection following hernia repair. There was 2 male and 5 female cases and age ranged from 38-58 years. With NPWT the mesh in 6 patients (86%) out of 7 could be completely salvaged and wound closed with secondary suturing. However, in 1 patient although the mesh covered with granulation tissue by NPWT and wound was closed; but it had to be partly removed later on due to development of chronic discharging sinus 20 days after stitch removal. \u0000Conclusion: The study demonstrated that NPWT was a useful technique for the treatment and preservation of infected mesh after hernia repair. \u0000IMC J Med Sci 2019; 13(1): 008","PeriodicalId":55816,"journal":{"name":"IMC Journal of Medical Science","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85959096","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}
Pub Date : 2019-06-29DOI: 10.3329/IMCJMS.V13I1.42038
Sadya Afroz, Smita Debsarma, S. Dutta, M. M. Rhaman, M. Mohsena
Background and objectives: Helminthic infestation is one of the commonest health problems in a developing country like Bangladesh. The objectives of the current study were to determine the prevalence of helminthic infestations, associated risk factors and its effects among the rural children in Bangladesh. The trend of helminthic infestation rate over time was also analyzed. Methodology: A cross-sectional study was conducted among the rural primary school children of Sreepur Upazilla of Gazipur District. The area is located about 40 km north-east of capital Dhaka. A total of 593 students aged 5-13 years were enrolled from 5 primary schools. Out of 593 children, 204 agreed to provide fecal samples. A semi-structured questionnaire was used to collect data by face to face interview method and several anthropometric measurements along with clinical examinations were also carried out. Helminth ova were detected by direct microscopy of fecal smear and floatation concentration methods. Data were analyzed using the software IBM SPSS (Version 20). Result: Out of 204, 80 (39.2%) children were infested with at least one species of helminth. Ascaris lumbricoides, Trichuris trichiura and mixed infection was 23%, 12.8% and 3.4% respectively. Overall prevalence of infection was higher among female students compared to male students (p<0.05). Living in mud-floor and thatch walled houses were significantly (p<0.05) associated with increased helminthic infestation. The risk behaviors commonly related to helminthic infestation revealed no difference between infected and non- infected groups of children. Height, weight, mid-upper arm circumference (MUAC), skin fold thickness, and waist and hip circumference of worm infested children were not significantly different from those without worm infestation. Conclusion: The results reflect that the deworming program of Sreepur Upazilla was not fully successful. Poor socio-economic condition and lack of awareness of personal hygiene played an important role in prevalence of parasite infestation. IMC J Med Sci 2019; 13(1): 004
{"title":"Prevalence of helminthic infestations among Bangladeshi rural children and its trend since mid-seventies","authors":"Sadya Afroz, Smita Debsarma, S. Dutta, M. M. Rhaman, M. Mohsena","doi":"10.3329/IMCJMS.V13I1.42038","DOIUrl":"https://doi.org/10.3329/IMCJMS.V13I1.42038","url":null,"abstract":"Background and objectives: Helminthic infestation is one of the commonest health problems in a developing country like Bangladesh. The objectives of the current study were to determine the prevalence of helminthic infestations, associated risk factors and its effects among the rural children in Bangladesh. The trend of helminthic infestation rate over time was also analyzed. \u0000Methodology: A cross-sectional study was conducted among the rural primary school children of Sreepur Upazilla of Gazipur District. The area is located about 40 km north-east of capital Dhaka. A total of 593 students aged 5-13 years were enrolled from 5 primary schools. Out of 593 children, 204 agreed to provide fecal samples. A semi-structured questionnaire was used to collect data by face to face interview method and several anthropometric measurements along with clinical examinations were also carried out. Helminth ova were detected by direct microscopy of fecal smear and floatation concentration methods. Data were analyzed using the software IBM SPSS (Version 20). \u0000Result: Out of 204, 80 (39.2%) children were infested with at least one species of helminth. Ascaris lumbricoides, Trichuris trichiura and mixed infection was 23%, 12.8% and 3.4% respectively. Overall prevalence of infection was higher among female students compared to male students (p<0.05). Living in mud-floor and thatch walled houses were significantly (p<0.05) associated with increased helminthic infestation. The risk behaviors commonly related to helminthic infestation revealed no difference between infected and non- infected groups of children. Height, weight, mid-upper arm circumference (MUAC), skin fold thickness, and waist and hip circumference of worm infested children were not significantly different from those without worm infestation. \u0000Conclusion: The results reflect that the deworming program of Sreepur Upazilla was not fully successful. Poor socio-economic condition and lack of awareness of personal hygiene played an important role in prevalence of parasite infestation. \u0000IMC J Med Sci 2019; 13(1): 004","PeriodicalId":55816,"journal":{"name":"IMC Journal of Medical Science","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78846751","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}
Pub Date : 2019-06-29DOI: 10.3329/IMCJMS.V13I1.42048
S. M. Shefin, N. Qureshi, A. Mir, Ahasnul Haq Amin, T. Ahmed, F. Afsana, Shah Alam, F. Akter, S. Emran, Tanjina Hossain, Shahjamal Khan, M. Mustari, N. Sultana, M. Saifuddin, S. Tuqan, S. Selim, S. K. Talukder, Rafiq Uddin, Feroz Amin
Spontaneous hypoglycemia is an important entity that may affect multiple organs. The differential diagnosis is broad in individuals with hypoglycemia in the absence of diabetes mellitus. Multiple etiologies may be present concurrently. Drugs, critical illnesses, hormone deficiencies, and non-islet cell tumors should be considered in those who are ill or taking medications. In apparently healthy individuals, endogenous hyperinsulinism due to insulinoma, functional β-cell disorders, or insulin autoimmune conditions are possible, as are accidental, surreptitious or factitious causes of hypoglycemia. Investigations should be guided by clinical scenario. Irrespective of the exact cause of the spontaneous hypoglycemia, treatment consists of correcting the glycemic state and preventing recurrence by alleviating underlying pathology. This review discusses the causes, diagnosis and management of spontaneous hypoglycemia. IMC J Med Sci 2019; 13(1): 001
{"title":"Spontaneous hypoglycemia: a review","authors":"S. M. Shefin, N. Qureshi, A. Mir, Ahasnul Haq Amin, T. Ahmed, F. Afsana, Shah Alam, F. Akter, S. Emran, Tanjina Hossain, Shahjamal Khan, M. Mustari, N. Sultana, M. Saifuddin, S. Tuqan, S. Selim, S. K. Talukder, Rafiq Uddin, Feroz Amin","doi":"10.3329/IMCJMS.V13I1.42048","DOIUrl":"https://doi.org/10.3329/IMCJMS.V13I1.42048","url":null,"abstract":"Spontaneous hypoglycemia is an important entity that may affect multiple organs. The differential diagnosis is broad in individuals with hypoglycemia in the absence of diabetes mellitus. Multiple etiologies may be present concurrently. Drugs, critical illnesses, hormone deficiencies, and non-islet cell tumors should be considered in those who are ill or taking medications. In apparently healthy individuals, endogenous hyperinsulinism due to insulinoma, functional β-cell disorders, or insulin autoimmune conditions are possible, as are accidental, surreptitious or factitious causes of hypoglycemia. Investigations should be guided by clinical scenario. Irrespective of the exact cause of the spontaneous hypoglycemia, treatment consists of correcting the glycemic state and preventing recurrence by alleviating underlying pathology. This review discusses the causes, diagnosis and management of spontaneous hypoglycemia. \u0000IMC J Med Sci 2019; 13(1): 001","PeriodicalId":55816,"journal":{"name":"IMC Journal of Medical Science","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88229695","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}
Pub Date : 2019-06-29DOI: 10.3329/IMCJMS.V13I1.42040
M. M. Rhaman, M. Morshed, M. Sayeed
Background and aims: Bangladesh produces 33% of the world’s jute and about 40 million people in Bangladesh are directly or indirectly involved in the jute sector. The jute (organic) dust inhalation causes byssinosis and other respiratory illnesses. However, no study has yet addressed the health status of the jute handlers/workers in Bangladesh. This study aimed to determine the prevalence of respiratory illnesses among the Jute Mill Workers (JMWs). Additionally, this study tried to find out the overall health status of the JMWs which included presence of non-communicable diseases (NCD) and its related risk, which are usually ignored. Study design: A cross-sectional study conducted in a purposively selected jute mill - 40km off from Dhaka City. Of the 5500 workers, a list of 600 workers was provided by the mill authority for enrollment in the study. The investigations included – a) interviewing on socio-demography and clinical history; b) anthropometry (height, weight, waist- and hip-circumference); c) blood pressure measurement; d) estimation of fasting blood glucose and lipids; e) peak flow meter test; f) spirometry; g) high resolution computerized tomography (HRCT) and electrocardiography. Results: Of the enlisted 600 jute mill workers, 514 (men / women = 478 / 36) took part in the study. The response rate was 85%. For overall estimate of bio-physical characteristics (n = 514), the means (95% confidence interval) of age, body mass index (BMI), waist-hip ratio (WHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 44.19 (43.34 – 45.04) years, 24.44 (24.16 – 24.73), 0.90 (0.90 – 0.91), 118.9 (117.4 – 120.4), 79.69 (78.81 – 8/0.54), respectively. Regarding social class and education, 84.4% were from non-affluent (poor) class and 50% were illiterate. About 88% of the JMWs had been working for ≥42 hours a week and 91.6% were exposed to moderate or heavy work (equivalent to ≥60 min walk). The prevalence of breathlessness, tightness of chest and chronic cough were 16.5%, 25.7% and 16.3%, respectively. The restrictive and obstructive pulmonary functions were detected in 7.0% and 0.8% of study population respectively. The prevalence of systolic hypertension was 16.5%, diastolic hypertension was 7.2% and diabetes (IFG+DM) was 13.3%. They had increased cardiovascular risks – hypertriglyceridemia (23.9%) and hypercholesterolemia (24.3%). Conclusions: JMWs have been suffering mostly from respiratory illnesses and a substantial number of them suffer from undiagnosed hypertension, diabetes and other non-communicable diseases. Dyslipidemia was also prevalent as a potential risk factor. The study could not assess ocular, auditory, musculoskeletal and mental health and it suggests that a well designed study should address these health related problems of JMWs. IMC J Med Sci 2019; 13(1): 007
{"title":"Respiratory and other illnesses among the jute-mill workers in an industrial unit of Bangladesh","authors":"M. M. Rhaman, M. Morshed, M. Sayeed","doi":"10.3329/IMCJMS.V13I1.42040","DOIUrl":"https://doi.org/10.3329/IMCJMS.V13I1.42040","url":null,"abstract":"Background and aims: Bangladesh produces 33% of the world’s jute and about 40 million people in Bangladesh are directly or indirectly involved in the jute sector. The jute (organic) dust inhalation causes byssinosis and other respiratory illnesses. However, no study has yet addressed the health status of the jute handlers/workers in Bangladesh. This study aimed to determine the prevalence of respiratory illnesses among the Jute Mill Workers (JMWs). Additionally, this study tried to find out the overall health status of the JMWs which included presence of non-communicable diseases (NCD) and its related risk, which are usually ignored. \u0000Study design: A cross-sectional study conducted in a purposively selected jute mill - 40km off from Dhaka City. Of the 5500 workers, a list of 600 workers was provided by the mill authority for enrollment in the study. The investigations included – a) interviewing on socio-demography and clinical history; b) anthropometry (height, weight, waist- and hip-circumference); c) blood pressure measurement; d) estimation of fasting blood glucose and lipids; e) peak flow meter test; f) spirometry; g) high resolution computerized tomography (HRCT) and electrocardiography. \u0000Results: Of the enlisted 600 jute mill workers, 514 (men / women = 478 / 36) took part in the study. The response rate was 85%. For overall estimate of bio-physical characteristics (n = 514), the means (95% confidence interval) of age, body mass index (BMI), waist-hip ratio (WHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 44.19 (43.34 – 45.04) years, 24.44 (24.16 – 24.73), 0.90 (0.90 – 0.91), 118.9 (117.4 – 120.4), 79.69 (78.81 – 8/0.54), respectively. Regarding social class and education, 84.4% were from non-affluent (poor) class and 50% were illiterate. About 88% of the JMWs had been working for ≥42 hours a week and 91.6% were exposed to moderate or heavy work (equivalent to ≥60 min walk). The prevalence of breathlessness, tightness of chest and chronic cough were 16.5%, 25.7% and 16.3%, respectively. The restrictive and obstructive pulmonary functions were detected in 7.0% and 0.8% of study population respectively. The prevalence of systolic hypertension was 16.5%, diastolic hypertension was 7.2% and diabetes (IFG+DM) was 13.3%. They had increased cardiovascular risks – hypertriglyceridemia (23.9%) and hypercholesterolemia (24.3%). \u0000Conclusions: JMWs have been suffering mostly from respiratory illnesses and a substantial number of them suffer from undiagnosed hypertension, diabetes and other non-communicable diseases. Dyslipidemia was also prevalent as a potential risk factor. The study could not assess ocular, auditory, musculoskeletal and mental health and it suggests that a well designed study should address these health related problems of JMWs. \u0000IMC J Med Sci 2019; 13(1): 007","PeriodicalId":55816,"journal":{"name":"IMC Journal of Medical Science","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83670374","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}
Pub Date : 2019-06-29DOI: 10.3329/IMCJMS.V13I1.42039
M. E. Ullah, Mushfiqur Rahman, R. H. Talukder, Refat Uddin Tareq, Noor A Alam
Background and objectives: Laparoscopic surgery is normally performed under general anesthesia (GA), but regional techniques like epidural or subarachnoid block (SAB) have been found beneficial in patients having associated major medical problems. In selected cases, it can be a safe alternative to GA. Hence, the present study was conducted to explore the safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy. Methods: Forty patients undergoing elective laparoscopic cholecystectomy and fulfilling specific inclusion criteria were included in the study. All patients received a segmental (L2-L3 injection) SAB with 3 ml (0.5%) of bupivacaine and 25 microgram of fentanyl. Laparoscopic cholecystectomy was done by standard 4 port technique. Intra-abdominal pressure was kept low at 9-10 mm Hg using CO2 pneumoperitoneum. Patients were followed up at 30 minutes, 4 hours, at the time of discharge and on day 7 after operation. Any unwanted voluntary or involuntary movement or exaggerated diaphragmatic excursion during the operation was monitored. Operation time, operating room (OR) occupancy time, hospital stay, post-operative pain, analgesic requirement, nausea, vomiting, headache, right shoulder pain, wound-related complications and patient satisfaction were recorded. Results: SAB was effective for surgery in all 40 patients. Two patients required conversion to general anesthesia for persisting low oxygen saturation. Hypotension was recorded in 23.7% patients while 10.5% experienced right shoulder pain. Average operating time was 37.3 minutes (21 - 77 minutes). Awkward movement and exaggerated respiratory excursion was noted in 23.7% and 18.4% cases respectively. Only two cases had to undergo (conversion to) GA. Mean period of hospital stay was 29.3 hours. No incidence of any major complication occurred. Conclusion: This study showed that SAB could be used successfully and effectively for laparoscopic cholecystectomy in healthy patients and may be a safe alternative to GA. IMC J Med Sci 2019; 13(1): 006
背景和目的:腹腔镜手术通常在全身麻醉(GA)下进行，但局部技术如硬膜外或蛛网膜下腔阻滞(SAB)已被发现对有相关重大医学问题的患者有益。在选定的情况下，它可以是一种安全的替代GA。因此，本研究旨在探讨SAB在其他健康个体行腹腔镜胆囊切除术时的安全性和可行性。方法:选取40例符合特定入选标准的择期腹腔镜胆囊切除术患者作为研究对象。所有患者均接受节段性(L2-L3注射)SAB，其中含有3ml(0.5%)布比卡因和25微克芬太尼。采用标准四孔技术行腹腔镜胆囊切除术。采用CO2气腹将腹内压保持在9-10 mm Hg。随访时间分别为30分钟、4小时、出院时和术后第7天。监测手术过程中任何不需要的自主或非自主运动或夸张的膈肌偏移。记录手术时间、手术室占用时间、住院时间、术后疼痛、镇痛需求、恶心、呕吐、头痛、右肩疼痛、伤口相关并发症及患者满意度。结果:40例患者SAB均有效。2例患者因持续低氧饱和度需要转全身麻醉。23.7%的患者出现低血压，10.5%的患者出现右肩疼痛。平均手术时间37.3分钟(21 ~ 77分钟)。23.7%和18.4%的患者出现动作困难和呼吸剧烈偏移。只有两例必须进行(转换)GA。平均住院时间29.3小时。无重大并发症发生。结论:本研究表明，SAB可以成功有效地用于健康患者的腹腔镜胆囊切除术，可能是一种安全的替代GA的方法。国际医学杂志2019;13 (1): 006
{"title":"Safety and feasibility of subarachnoid block in laparoscopic cholecystectomy","authors":"M. E. Ullah, Mushfiqur Rahman, R. H. Talukder, Refat Uddin Tareq, Noor A Alam","doi":"10.3329/IMCJMS.V13I1.42039","DOIUrl":"https://doi.org/10.3329/IMCJMS.V13I1.42039","url":null,"abstract":"Background and objectives: Laparoscopic surgery is normally performed under general anesthesia (GA), but regional techniques like epidural or subarachnoid block (SAB) have been found beneficial in patients having associated major medical problems. In selected cases, it can be a safe alternative to GA. Hence, the present study was conducted to explore the safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy. \u0000Methods: Forty patients undergoing elective laparoscopic cholecystectomy and fulfilling specific inclusion criteria were included in the study. All patients received a segmental (L2-L3 injection) SAB with 3 ml (0.5%) of bupivacaine and 25 microgram of fentanyl. Laparoscopic cholecystectomy was done by standard 4 port technique. Intra-abdominal pressure was kept low at 9-10 mm Hg using CO2 pneumoperitoneum. Patients were followed up at 30 minutes, 4 hours, at the time of discharge and on day 7 after operation. Any unwanted voluntary or involuntary movement or exaggerated diaphragmatic excursion during the operation was monitored. Operation time, operating room (OR) occupancy time, hospital stay, post-operative pain, analgesic requirement, nausea, vomiting, headache, right shoulder pain, wound-related complications and patient satisfaction were recorded. \u0000Results: SAB was effective for surgery in all 40 patients. Two patients required conversion to general anesthesia for persisting low oxygen saturation. Hypotension was recorded in 23.7% patients while 10.5% experienced right shoulder pain. Average operating time was 37.3 minutes (21 - 77 minutes). Awkward movement and exaggerated respiratory excursion was noted in 23.7% and 18.4% cases respectively. Only two cases had to undergo (conversion to) GA. Mean period of hospital stay was 29.3 hours. No incidence of any major complication occurred. \u0000Conclusion: This study showed that SAB could be used successfully and effectively for laparoscopic cholecystectomy in healthy patients and may be a safe alternative to GA. \u0000IMC J Med Sci 2019; 13(1): 006","PeriodicalId":55816,"journal":{"name":"IMC Journal of Medical Science","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89115576","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}
Pub Date : 2019-06-01DOI: 10.3329/IMCJMS.V13I1.42050
O. Ogungbe, A. Mitra, Joni K Roberts
Background and objectives: Health disparities are a growing concern in health care. Research provides ample evidence of bias in patient care and mistrust between patient and providers in ways that could perpetuate health care disparities. This study aimed to review existing literature on implicit bias (or unconscious bias) in healthcare settings and determine studies that have considered adverse effects of bias of more than one domain of social identity (e.g., race and gender bias) in health care. Methods: This is a systematic review of articles using databases such as EBSCO, Embase, CINAHL, COCHRANE, Google Scholar, PsychINFO, Pub Med, and Web of Science. Search terms included implicit bias, unconscious bias, healthcare, and public health. The inclusion criteria included studies that assessed implicit bias in a healthcare setting, written in English, and published from 1997-2018. Results: Thirty-five articles met the selection criteria – 15 of which examined race implicit bias, ten examined weight bias, four assessed race and social class, two examined sexual orientation, two focused on mental illness, one measured race and sexual orientation, and another investigated age bias. Conclusions: Studies that measured more than one domain of social identity of an individual did so separately without investigating how the domains overlapped. Implicit Association Test (IAT) is a widely used psychological test which is used to determine existence of an implicit bias in an individual. However, this study did not find any use of an instrument that could assess implicit bias toward multiple domains of social identities. Because of possible multiplicative effects of several biases affecting a single entity, this study suggests the importance of developing a tool in measuring intersectionality of biases. IMC J Med Sci 2019; 13(1): 005
背景和目的:保健方面的健康差距日益受到关注。研究提供了充足的证据表明，在病人护理方面存在偏见，病人和提供者之间存在不信任，这些可能会使医疗保健差距永久化。本研究旨在回顾现有的关于医疗保健环境中的内隐偏见(或无意识偏见)的文献，并确定考虑了医疗保健中多个社会认同领域偏见(例如种族和性别偏见)的不利影响的研究。方法:这是一个使用EBSCO、Embase、CINAHL、COCHRANE、Google Scholar、PsychINFO、Pub Med和Web of Science等数据库的文章的系统综述。搜索词包括隐性偏见、无意识偏见、医疗保健和公共卫生。纳入标准包括在医疗保健环境中评估内隐偏见的研究，以英文撰写，发表于1997-2018年。结果:35篇文章符合入选标准，其中15篇研究种族内隐偏见，10篇研究体重偏见，4篇研究种族和社会阶层，2篇研究性取向，2篇研究精神疾病，1篇研究种族和性取向，另一篇研究年龄偏见。结论:测量一个人的多个社会认同领域的研究是单独进行的，而没有调查这些领域是如何重叠的。内隐联想测验(IAT)是一种广泛使用的心理测验，用于确定个体是否存在内隐偏见。然而，这项研究没有发现任何工具的使用，可以评估对社会身份的多个领域的内隐偏见。由于影响单个实体的几个偏差可能产生多重效应，本研究表明开发一种测量偏差交叉性的工具的重要性。国际医学杂志2019;13 (1): 005
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Pub Date : 2019-01-07DOI: 10.3329/IMCJMS.V12I2.39667
S. Ikhtaire
We report a case of nephrotic range proteinuria with 24-hour urine protein level of 18.3 g/day, which developed following dengue fever (DF). The patient did not exhibit classical features of nephrotic syndrome (NS) and his renal function was not compromised during his illness. Proteinuria resolved without any specific treatment and precluded renal biopsy. Though the dengue fever and associated renal disorders are self-limiting, renal involvement in severe dengue infection is growingly seen in recent years and could cause increased mortality and long-term morbidity. IMC J Med Sci 2018; 12(2): 86-89
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Pub Date : 2019-01-07DOI: 10.3329/imcjms.v12i2.39662
A. Mitra, A. Imtiaz, Yusuf A Al Ibrahim, Mohammad B Bulbanat, Maha F Al Mutairi, Sulaiman F Al Musaileem
Background and objectives: Self-medication is commonly practiced throughout the world. The aim of this study was to ascertain the use prevalence and knowledge of harmful effects of selfmedication among college students of health professions and non-health professions. Methods: A cross-sectional study was performed among 1,167 students from 12 faculties of a public university and two private universities in Kuwait. Data were collected using a selfadministered pretested questionnaire containing 32 questions. Results: Among the participants, 70.4% (822/1,167) used self-medication. The prevalence of self-medication was significantly higher among students of non-health professions compared with those of health professions (35.9% vs. 25.9%, p = 0.004, 95% CI, 6.28% to 13.73%, respectively). Pain killer medicines (52.9%), vitamins/minerals (13.1%), and antihistamines (9.0%) were the most commonly used non-prescription medications. Antibiotics and sleeping pills were used without a prescription in 2.9% and 2.1%, respectively. Older age, non-Kuwaiti national, and students of 5th to 7th year of study were significant predictors of self-medication. Knowledge scores of harmful effects of self-medication were about two-fold higher among females than their male counterparts. Similarly, students of higher years of study (5th to 7th year) had higher knowledge score compared with others. Conclusions: The prevalence of self-medication was alarmingly high among young adults in Kuwait. People should be informed about adverse effects of self-medication through mass and social media campaign. IMC J Med Sci 2018; 12(2): 57-68
背景和目的:自我药疗在世界各地都很普遍。摘要本研究旨在了解卫生专业与非卫生专业大学生自我药疗的使用情况及对其有害影响的认知。方法:对来自科威特一所公立大学和两所私立大学12个院系的1167名学生进行横断面研究。数据收集使用一份包含32个问题的自填预测问卷。结果:70.4%(822/ 1167)的患者使用自我药疗。非卫生专业学生的自我药疗患病率明显高于卫生专业学生(35.9% vs. 25.9%， p = 0.004, 95% CI，分别为6.28% ~ 13.73%)。止痛药(52.9%)、维生素/矿物质(13.1%)和抗组胺药(9.0%)是最常用的非处方药。无处方使用抗生素和安眠药的比例分别为2.9%和2.1%。年龄较大、非科威特国民和5至7年级的学生是自我药物治疗的显著预测因子。女性对自我药疗有害影响的认知得分是男性的两倍。同样，高年级(5 - 7年级)学生的知识得分也高于其他学生。结论:自我药疗在科威特年轻人中的流行程度高得惊人。人们应该通过大众和社交媒体宣传了解自我药疗的不良影响。国际医学杂志2018;12 (2): 57 - 68
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Pub Date : 2019-01-07DOI: 10.3329/IMCJMS.V12I2.39661
H. Momtaz, Nehlin Tomalika, M. Mohsena, Mir Masudur Rhahman, N. Sultana, M. Sayeed
Background and objectives: World Health Organization (WHO) and the National Health Policy of Bangladesh have repeatedly been emphasizing on the use of essential drugs prescribed by generic names. The prescription monitoring studies provide a bridge between areas like rational use of drugs and evidence based medicine. Knowledge on distribution and burden of diseases in a community is essential for planning rational use of drugs in a community. The present study tried to determine the morbidity profile and drug prescribing practices of healthcare providers in a rural primary health care. Methods: The study was conducted at a rural health center located 50 Km north of capital city Dhaka. A semi-structured questionnaire was used for collecting data on socio-demographic conditions, clinical complaints and types of drugs prescribed. WHO prescribing indicators was used to find out the drug prescribing pattern. Results: A total of 583 patients were enrolled. Problems related to respiratory system (21.1%), musculoskeletal system (17.3%) and skin diseases (11.1%) were common reasons for visiting health centre. Oral drugs were prescribed with highest proportion (96.1%). More than half (62.6%) of the drugs were prescribed from essential drug list. About half (49.1%) were antibiotics and 45.6% of the drugs were prescribed in their generic name. Anti-microbial (64.5%), anti-peptic ulcer (43.1%) and NSAIDs (42.5%) were most frequently prescribed. Out of five WHO core prescription indicators, four were below the acceptable values. Conclusion: The study demonstrated that there is an urgent need to promote rational use of drugs among the healthcare providers. IMC J Med Sci 2018; 12(2): 50-56
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