Innovations in Medicine and Medical Research Vol. 1

Subjective Experiences of Antipsychotic Treatment: A Comparison of First and Second-generation Medications among Patients with Schizophrenia

Nisha Warikoo — 2020-02-11

Aims: The patient’s perspective of antipsychotic treatment has been a relatively neglected area of research. Whether subjective experiences of antipsychotic treatment are better among patients on second-generation antipsychotics (SGAs), than those on first-generation antipsychotics (FGAs) has also evoked some controversy. This study attempted a longitudinal comparison of attitudes toward treatment, subjective well-being and quality of life (QOL) between patients on SGAs and FGAs. Socio-demographic and clinical correlates of these subjective experiences were also examined.

Methodology: Standardised ratings of insight, psychopathology, side-effects, attitudes, subjective well-being and QOL were carried out among 40 patients with schizophrenia on SGAs and 30 on FGAs, over a 6-month period.

Results: Both groups were similar in the first 3-month period, apart from the slightly greater severity of illness in the FGA group. Differences in symptom-severity and side-effects emerged between the groups over the course of follow-up. Moreover, as the study progressed, differences also became apparent in subjective experiences; patients on SGAs had significantly better attitudes, subjective well-being and QOL than those on FGAs. However, differences between individual SGAs (olanzapine and risperidone) on these indices were minimal. The three indices of subjective experience were highly correlated with each other. Older age, being employed, greater insight, lower symptom-severity and the absence of side-effects demonstrated significant positive associations with different aspects of subjective experiences.

Conclusions: Patients on SGAs had a more favourable profile of subjective experiences with treatment than those on FGAs. These differences seemed to be determined mainly by differences in symptom-severity and side-effects.

Birth Weight and Future Life-span in Finnish Triplets

Johan Fellman — 2020-02-11

Aims: Interest in the distribution of birth weight arises because of the association between birth weight and the future health of the child. A common statistical result is that the birth weight distribution differs slightly from the Gaussian distribution.

Methods: A standard attempt has been done to split the distribution into two components, a predominant Gaussian distribution and an unspecified “residual” distribution.

Results: We considered birth weight data among triplets born in Finland in 1905-1959 and compare the birth weight among stillborn and live-born triplets. The stillbirth rates are 119.1 per 1000 births for males, 124.6 for females and 121.8 for all. The sex differences are not significant. The still birth rate for the period 1905-1930 was 119.5 and for the period 1931-1959, 124.2. We identified a strong association between birth weight of the triplets and their survival. The weight distribution for male triplets is described well by the Gaussian curve, while for females a slight deviation from the Gaussian distribution is discernible.

Prevalence of Clinically Concealed Prostatic Diseases at Post Mortem: A Teaching Hospital Experience in South-South, Nigeria

E. Imasogie Dele — 2020-02-11

Background: Most post-mortem studies on prostate gland are limited to malignant prostatic tumours. The possibilities of finding other histological types of prostatic diseases were worth exploring bearing in mind that Nodular hyperplasia and cancer are of epidemiological importance.

Aim: This study aims to determine the pattern of prostatic diseases at post-mortem among individuals not previously diagnosed with prostate disease and who died from other causes.

Materials and Methods: Prostate glands at post-mortem were obtained from individuals who died from non-prostate related causes, weighed, fixed in 10% neutral buffered formalin, processed and histologically analysed. Biodata and clinical diagnoses were obtained using clinical case notes and post-mortem register.

Results: The population under study were 86 adult males whose ages ranged from 30 to 85 years with a mean age of 52.71 ± 13.10 years. Ninety-three percent (93% / 80 cases) of the study population were afflicted with prostatic diseases at post-mortem. The most common lesion was nodular hyperplasia. Latent or occult adenocarcinoma followed this, prostatic intraepithelial neoplasia and Schistosomiasis in decreasing order of frequency. The frequency of occult adenocarcinoma, prostatic intraepithelial neoplasia (PIN) and nodular hyperplasia increased significantly with age (P ≤ 0.05). The peak age for the development of occult adenocarcinoma, PIN and nodular hyperplasia was in the 6^th, 8^th and 6^th decades respectively.

Conclusion: Clinically concealed prostatic diseases are common findings at post-mortem. There is a significant increase (P ≤ 0.05) in the frequency of covert prostatic diseases (nodular hyperplasia, PIN and adenocarcinoma) with advancing age. Convert prostatic diseases especially nodular hyperplasia and prostatic carcinoma have the potentials of contributing significantly to the burden of health care and the cost of receiving treatment if the life expectancy improves in our environment in particular and Nigeria in general.

Clinical Epidemiology of Chickenpox in Iraq, 2007-2011

Hanan Abdulghafoor Khaleel — 2020-02-11

Chickenpox (Varicella zoster) infection is an acute disease caused by varicella zoster virus (VZV). In endemic areas, primary infection tends to occur at a younger age. The World Health Organization (WHO) recommended that routine childhood varicella vaccination should be considered in countries where the disease is a relatively important public health and socioeconomic problem, and where high (85 to 90%) and sustained vaccine coverage can be achieved.

Aim: 1- To describe the epidemiology (occurrence, age, gender and season) of registered clinical cases of chickenpox in Iraq from 2007-2011, 2- To determine the need for the use of chickenpox vaccine in Iraq.

Methods: A retrospective descriptive analysis of surveillance data. Frequency and percentage were used to describe the data. The occurrence per 100,000 of Iraqi population was calculated. Chi square test was used.

Results: There was an obvious rise in the registration of clinical chickenpox cases from 21,798 case in 2007 to 74, 195 case in 2011. This corresponds to an increase in the occurrence rate of clinical chickenpox cases from 73.41/100,000 in 2007 to 222.61/100, 000 in 2011. There were possible outbreaks in 2008 and 2011. The occurrence of chickenpox showed the same seasonal distribution throughout the years 2007-2011, being highest in spring (April, May) season. The highest registered number of chickenpox cases was in provinces of Ninawa, Baghdad/Russafa, Dihok, Baghdad/Karkh, Al-Basrah and As-Sulaymaniyah. There was a sustained preponderance for the males over females with nearly the same percentage over the years. Most of the cases occurred in those of age 5-14 years (65%), only 1% occur in those >45 years with statistical significance p=0.001.

Conclusions: There is a rising trend in the registration of clinical chickenpox cases. Most cases occur in the age group of less than 15 years. Males are slightly higher than females. The highest frequencies were reported in March, April and May. Most of the cases were registered in Baghdad, Ninawa, Dihok and Al-Basrah.

Perception of Early Pregnancy Symptoms among Antenatal Women in Port Harcourt, Southern Nigeria

Ikobho Ebenezer Howells — 2020-02-11

Background: Early pregnancy symptoms are commonly experienced by most women during pregnancy. While some such as missed periods may serve as an early warning symptom, others may be troublesome, necessitating treatment, and even hospital admission.

Objective: The main objective of this study is to determine the pattern of early pregnancy symptoms among pregnant women in Port Harcourt, Southern Nigeria. Specifically, it would determine the type of symptoms, the period of onset, climax, and when they subside. It would also determine the recurrence rate and the maternal effects in the index pregnancy.

Materials and Methods: A cross-sectional observational study of 616 booked pregnant women who attended antenatal care at the department of obstetrics and gynaecology, University of Port Harcourt Teaching Hospital, from February 2015 to January 2016. The patients were educated about early pregnancy symptoms, and relevant questions and concerns were addressed. Verbal consent was obtained from those who agreed to participate; a structured questionnaire was then distributed among the participants, which was filled and data were analyzed.

Results: The prevalence rate for early pregnancy symptoms was very high 89.6%, the symptoms were commoner among primigravid women 208(33.8%) and they tend to reduce significantly with increasing parity. The recurrent rate among parous women was high 82.6%.

The mean gestational age at onset of symptoms was 4.06 ± 1.64 weeks and by eight weeks, about 87% of the women have developed pregnancy symptoms. The symptoms were perceived to be worse between 5 and eight weeks, with a mean of 7.20 ± 2.15 weeks and they started to subside by 9 – 12 weeks, with a mean of 14.06 ± 3.85 weeks.

Amenorrhoea was the commonest symptom 98.6%, followed by nausea and vomiting 52.3%, then breast pain and heaviness 52.3%, low back pain 45.3% and urinary symptoms 36.4%. Pregnancy symptoms interfered very little with professional and domestic activities, and the hospital admission rate was quite low 8.4%.

Conclusion: Women hardly go through pregnancy without experiencing multiple pregnancy symptoms. The prevalence rate was high, especially among Primigravidas and symptoms tend to be recurrent among multiparous women. Pregnancy symptoms tend to peak around 5 – 8 weeks and begin to subside by 9 -12 weeks.

Self Esteem among Adolescents in Nigerian Secondary Schools: A Neglected Issue

Josephat M. Chinawa — 2020-02-11

Background: Self esteem among adolescents is a neglected issue in pediatrics, especially in this part of the world. Females ages fourteen to seventeen seemed to have positive self-esteem and so do the males but self esteem is low at middle ages. Females tend to have a low self esteem than males.

Objectives: The objective of this study is to determine the pattern of self esteem among adolescents and associated factors.

Methods: The study was carried out among adolescents attending secondary schools from two cities; (Enugu and Abakiliki located in south eastern part of Nigeria) within age range of 10-19 yr. A structured self administered questionnaire developed from self esteem scores was used for data collection.

Pearson’s chi-square was used to test for relationship between categorical variables while student t- test was used to test significant relationship between continuous variables. Test of significance was set at p<0.5.

Results: The self esteem questionnaire used was classified into two major questions with several sub questions. The first group is about self confidence, self fulfillment and self worth and confidence, the second group include depression, hopelessness, loneliness, and suicidal thoughts. We enrolled 507 adolescents in this study. The mean age of all participants was 16.3 (1.2) yr. Total mean self esteem score for all respondents is 15.77±2.769. Low self esteem was observed in 3.6% of the respondents with 4.3% of females and 2.5% of Males. Low self esteem is mostly seen in older adolescents aged 18-19 (44%) and rare among (adolescents less than 11 yr (0%). Low self esteem was more common among the female respondents in all the age ranges.

Conclusion: Self esteem is high among adolescents, though this is may be overemphasized as more research is needed in this area.

A Comparison of Rheumatoid Arthritis Patients in Kuwait with Other Populations: Results from the KRRD Registry

Adeeba Al-Herz — 2020-02-11

Objective: Data on rheumatoid arthritis (RA) in Kuwait and The Middle East is scarce. Available data from Western countries may not be representative of the region. We describe RA patients in Kuwait and compare them with other RA populations and with Kuwaiti general population.

Methods: Adult RA patients from Kuwait Registry for Rheumatic Diseases (KRRD), the first RA registry in The Middle East, were studied from February 2013 through February 2015. Demographic, clinical and serologic data were compared with other RA populations and with Kuwaiti general population.

Results: 835 patients were enrolled, 62.3% female. Mean age 50.6±12 years and disease duration 6.1±6 years. RA was diagnosed at a mean age of 44.9±12 years. 17.1% had family history of autoimmune rheumatic diseases. 3.1% had rheumatoid nodules. Rheumatoid factor (RF) and anti-citrullinated peptide (ACPA) were detected in 75.6% and 57.8%, respectively. Both were positive in 49% (r=0.287, p=0.001). ANA was positive in 19.1%. Both ACPA and a combination of positive RF and ACPA were more in males (p=0.017, 0.004 respectively), whereas ANA was more in females (p=0.01). One third of male patients were smokers versus 1.9% of females. Smoking was correlated to RF (p=0.009) and ACPA (p=0,002). Difference in ACPA between genders was statistically explained by the predominance of smoking in males. Comorbidities included diabetes mellitus (DM) (20.8%), hypertension (20.2%), hyperlipidemia (10.5%) and coronary artery disease (CAD) (3.1%). 4 cases of cancer were reported.

Conclusion: RA population in Kuwait includes less women than other RA populations but more than Kuwaiti general population. Family history is more common. A higher positive ACPA in males was explained by smoking difference. Hypertension and hyperlipidemia were less reported than in both Kuwaiti general population and other RA populations. CAD was similar to other RA populations. DM was more reported, reflecting its high background prevalence in Kuwait.

Blood Groups and Periodontal Disease

Varma Siddhartha — 2020-02-11

The presence of putative periodontal pathogens is crucial to the development of inflammatory periodontal disease, but host immunity and other risk factors may also play a role in its progression. Genetic factors may act as a protective or risk factor. ABO blood groups are the most investigated erythrocyte antigen system. The presence or absence of blood group antigens has been associated with various diseases, with antigens also acting as receptors for infectious agents. However, varied literature is documented exploring the relationship between ABO blood group and prevalence of oral and dental diseases. The aim of this study was to investigate the correlation of periodontal disease with “ABO” blood groups and Rhesus factor.

A total of 684 systemically healthy subjects who were non smokers were selected by chance. Subjects with known blood group, who had at least 20 teeth, were included in the study and the blood groups were confirmed from their medical records. Based on the periodontal parameters like clinical attachment loss (CAL) and bleeding on probing (BOP) the subjects were divided into three groups: Healthy, gingivitis and periodontitis. The percentage distribution of ABO blood groups and Rhesus factor among the groups was tabulated. Results suggested that, there was an increased prevalence of gingivitis in subjects with blood group ‘A’ and periodontitis in subjects with blood group ‘O’, while subjects with blood group ‘B’ had healthy periodontium. Similarly, there was higher prevalence of gingivitis in Rh positive group. Based on our findings, a significant relationship between blood typing and periodontal disease was determined in this study. Further research into this is indicated.

Movement Disorder Early in the Presentation of Two Children with Subacute Sclerosing Pan-Encephalitis

Hanin Al-Gethami — 2020-02-11

Subacute sclerosing panencephalitis (SSPE) is a progressive degenerative disease caused by measles infection with overall poor prognosis in spite multiple modalities of treatment. The course of the disease is characterized by progressive neurological decline in the form of behavioral and personality changes followed by a stage of characteristic periodic myoclonic spasms followed by a stage of quadriplegia movement disorder, vegetative state and frequently early death. Here we report two cases with atypical presentation of early rather than late movement disorder during illness and the unusual association of central precocious puberty preceding the course of illness in one of the cases.

The White Coat and the Physician: A Snapshot of the Physicians’ Perspective

Herbert A. Obu — 2020-02-11

Background: The white coat is synonymous with medical profession and helps for easy identification by patients and colleagues.

Objectives: The objective of this study is to determine doctors’ perception on mode of dressing of their colleagues, especially wearing of white coats and its influence on the well being of their patients.

Methods: A structured self administered questionnaire was used to collect information from the doctors of all carder in the hospital during the study period. Three photographs, a man with corporate attire and tie without ward coat and the same man with corporate attire and tie with a white coat and same man with casual dressing, were shown to the doctors, and were asked which of the three pictures they would like a doctor to dress.

Results: Majority 200 (72.5%) of the respondents had a white coat on as at the time they were filling the questionnaire while only 76 (27.5%) were not putting on lab coat. Also 202 (75.9%) of the respondents are of the opinion that a doctor should always put on shirt, tie and trouser with a white covering lab coat. Most 76 (35.68%) of those who supported the opinion suggested that the white coat protects the doctors/or their families as their reason.

Conclusion: White coats were seen as the most appropriate dress code for doctors, regardless of gender. Low ranked doctors however wear the white coat more than high ranked ones. Furthermore the type of clothing and accessories used by physicians (physician dressed on shirt, tie and trousers with a white covering lab coat) has a positive influence on physician-patient relationship.

Antibacterial Activity of Polyphenolic Extracts from Different Algerian Honeys against Methicillin Resistant Staphylococcus aureus

Belkhodja Hamza — 2020-02-11

The prevalence of patients infected with Methicillin resistant Staphylococcus aureus present different problems of nosocomial infections diseases in addition to multidrug resistance. This work aim to evaluate the antibacterial effect of four polyphenolic extracts from honey against Methicillin resistant Staphylococcus aureus. An extraction of polyphenol was carried out from different honey samples collected from different regions of the Algerian territory. First, the physicochemical, microbiological quality and pollen analysis was studied. Then, the evaluation of the antibacterial effect was performed by the determination of inhibition diameter and the minimal inhibitory concentration. The results clearly show the sensitivity of Methicillin Resistant Staphylococcus aureus against the polyphenolic extracts. The four samples presented an inhibitory effect and the polyphenolic extract of Jijel has the highest inhibitory effect among all extracts. This activity depend not only with the type of polyphenolic compounds but also with the botanical origin and the type of honey as honeydew honeys which is more effective than nectar honey.

Factors Affecting the Surgical Outcome of Primary Exotropia in Children

S. Al Mahdi Huda — 2020-02-11

Objective: The objective of current study to evaluate the outcome results of the surgical correction and as well as the effects of some factors on the outcome and surgical response of primary exotropia.

Study Design: Retrospective Clinical Study.

Place and Duration of Study: Hamad Medical Corporation– Tertiary Hospital in Qatar, study done over six months.

Methods: Medical records of patients who underwent surgical correction of primary exotropia procedures between the years 2008 and 2013 were retrospectively reviewed. Patients less than 15 years of age were included in the study and the following data were collected: Onset age of squint, age at surgery, type of exotropia, visual acuity, presence of amblyopia, anisometropia, refractive error (spherical equivalent), preoperative deviation, AV pattern, stereopsis, type of surgery and analysis using descriptive statistics, unpaired t- and chi-square statistical tests.

Results: Of 74 patients we studied, 30 Male (40.5%), 44 Female (59.5%), 46 patients (62.2%) had successful surgical outcome and 28 patients (37.8%) had unsuccessful outcome (all under correction). The response to surgery correlated mainly to with the preoperative angle. A higher response resulted from larger preoperative deviation and it this was better with lateral plus medial rectus muscle recessions than with bilateral lateral rectus recession.

Conclusions: Preoperative deviation was the most important factor in determining better response to surgical correction of primary exotropia and accurate measurement of the angle of deviation can improve the outcome and response to surgery.

Attitude and Perception to Tattoos and Scarified Skin Marks in Makurdi, North Central Nigeria

P. Denen Akaa — 2020-02-11

Aim: Tattoo art which has been practiced all over the world for centuries is undergoing a revolution. Some people like it, others don’t. The aim of the study was to estimate the prevalence of tattooing among students and residents of Makurdi, like or dislike, who gave consent before tattooing, symbolism/motive of tattooing and whom to go to for removal of tattoos.

Study Design: A survey research using structured questionnaire as instrument for data collection among students of Benue State University and residents of Makurdi over a period of one month in January, 2017.

Methodology: Views of one hundred and seventy two residents and students in Makurdi, North Central Nigeria, were collated via a pre-tested structured questionnaire and analyzed on the basis of sex, age, like/dislike of tattoos, symbolism, consent given, whether one would tattoo himself if given a chance and what to do when one got tired of tattoos.

Results: Two hundred and ten questionnaires were administered and one hundred and seventy two were returned giving attrition rate of 18.1%. All returned questionnaires were completely filled. One hundred and seventy two respondents participated in the study comprising 123 males and 49 females giving a male to female ratio of 2.5:1. Twenty one respondents had tattoos giving a tattoo prevalence of 12.2%. One hundred and thirty eight (80.2%) did not like tattoos and forty two (24.4%) indicated that there was no significance to symbolism of tattoos and indeed thirty (17.4%) felt tattoos are a body mutilation. One hundred and fifty one (87.8%) indicated they will not have tattoos when given a chance to do so. Ninety seven (56.4%) believed the best person to go to for tattoo removal is a Plastic Surgeon.

Conclusion: The study showed that majority of students and residents of Makurdi metropolis in Nigeria do not like tattoos and would not like to have one when given a chance to do so. A large scale study involving other parts of Nigeria needs to be done to assess a true like/dislike of tattoos in this environment.

“Tibial Blowout”- A Complication of Arthroscopic Anterior Cruciate Ligament Reconstruction

A. Raviraj — 2020-02-11

The reconstruction of Anterior Cruciate Ligament (ACL) has become the standard of care for a torn ACL in active, young athletes. Various technical complications during the surgery are documented. Of the complications pertaining to the bony tunnel preparation, the posterior femoral blow out is common. In this report we describe a complication that can occur while preparing the Tibial tunnel – “Tibial blow out”. This is a complication of anterior placement of the tibial tunnel and this has not been reported in the literature. We describe the identification, the possible mechanism, prevention and management of such an intra operative complication.

Economic Burden of Diabetic Tuberculosis Patients from 3 Malaysian Hospitals

Daud M. I. Aweis — 2020-02-11

Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment.

Study Design: Prevalence based cohort.

Place and Duration of Study: Penang General Hospital, Hospital USM, and – Univesiti Malaya Medical Center; 2005 – 2008.

Methods: Study patients were placed in the TB only, DM only, or DM-TB groups, with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests.

Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DM only group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for the TB only and DM only groups, respectively.

Conclusions: DM antedated HTN in our patients. Durations of both DM and HTN were longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.

Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature

Ketan Vagholkar — 2020-02-11

Background: Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.

Introduction: Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations.

Case Report: A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition.

Discussion: The etiopathogenesis, presentation, investigations and management are discussed briefly.

Conclusion: Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

Leiomyoma of the Vulva: A Diagnostic Challenge Case Report

Saad Kurdi — 2020-02-11

Uterine leiomyomas are common and can affect up to 30% of women older than 35 years. Despite this, leiomyomas of the vulva are rare, masquerading and usually misdiagnosed as Bartholin cyst preoperatively. These smooth muscle tumors are typically painless, solitary and well circumscribed and can affect female of any age group. We present a case of a 46-year-old female that presented to the clinic with 2-year history of right labial mass and was diagnosed as Bartholin cyst initially. The patient underwent elective excision under spinal anaesthesia and the mass was removed. The final diagnosis after microscopy result showed benign vulvar leiomyoma.