European Journal of Medical and Health Sciences https://ej-med.org/index.php/ejmed European Journal of Medical and Health Sciences en-US editor@ej-med.org (Editor-in-Chief) editor@ej-med.org (Support) Wed, 01 Sep 2021 00:00:00 -0400 OJS 3.3.0.7 http://blogs.law.harvard.edu/tech/rss 60 Nevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome) in Children https://ej-med.org/index.php/ejmed/article/view/888 <div> <p class="p1"><span class="s1"><span lang="EN-US"><em>Introduction:</em> Gorlin syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is a rare genetic disorder characterised by development of multiple basal cell carcinomas (BCC) at a young age.</span></span></p> <p class="p1"><em style="font-size: 0.875rem;">Case report:</em><span style="font-size: 0.875rem;"> A 7 year female child presented with MULTIPLE skin growths on the neck, face and upper chest for 3 years, with prominent forehead and mild non-scarring alopecia. She also had a history of medulloblastoma treated 3 years ago. There was no significant family history. Biopsy from one of the lesions showed basal cell carcinoma (BCC).</span></p> </div> <div> <p class="p1"><span class="s1"><span lang="EN-US"><em>Discussion:</em> Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominantly inherited disorder caused by mutations in the tumour suppressor patched 1 (PTCH-1) gene. Patients present with both cutaneous and extra-cutaneous manifestations. Multiple basal cell carcinomas (BCCs) are one of the most frequent cutaneous manifestations, occurring on both photo-exposed and non-exposed areas. The commonest extra-cutaneous tumours are medulloblastomas, which are often the first presentation of the disease. There are multiple but no established treatment modalities for the disease.</span></span></p> </div> S. Binsheikhan, S. Mittal, M. Al Abadie Copyright (c) 2021 S. Binsheikhan, S. Mittal, M. Al Abadie http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/888 Thu, 30 Sep 2021 00:00:00 -0400 Herpes Zoster Anterior Uveitis with Hyphaema https://ej-med.org/index.php/ejmed/article/view/1010 <div> <p class="Text"><span lang="EN-US">Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.</span></p> </div> Rajagopal Arvinth, Mimiwati Zahari, Sagili Chandrasekhara Reddy Copyright (c) 2021 Rajagopal Arvinth, Mimiwati Zahari, Sagili Chandrasekhara Reddy http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1010 Fri, 03 Sep 2021 00:00:00 -0400 Primary Hyperparathyroidism Superimposed on a Pre-existing Familial Hypocalciuric Hypercalcemia Diagnosis https://ej-med.org/index.php/ejmed/article/view/1023 <div> <p class="Text"><span lang="EN-US">Familial hypocalciuric hypercalcemia is a rare clinical condition of persistently elevated serum calcium and reduced urinary calcium levels with an autosomal dominance inheritance pattern to the three out of four large types of this condition known. This rare condition goes largely undiagnosed as patients are largely asymptomatic and where symptoms are present, other causes of hypercalcemia are considered first. Hyperparathyroidism, super-imposing on FHH, is an even rarer occurrence. We present the case of an adult male with an initial provisional assessment of FHH, which was later confirmed with a genetic study. He went on to develop hyperparathyroidism (with evident enlarged parathyroid glands on Sestamibi parathyroid scan done, and an eventual histologic diagnosis of parathyroid adenoma after surgery). It remains to be established if this is an incidental occurrence or if there is a causal relationship between FHH and an onward development of parathyroid hypertrophy or adenoma(ta).</span></p> </div> Alamin Alkundi, Rabiu Momoh Copyright (c) 2021 Alamin Alkundi, Rabiu Momoh http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1023 Tue, 14 Sep 2021 00:00:00 -0400 Acyanotic Truncus Arteriosus Type 4 in a Sudden Infant Death: A Case Report https://ej-med.org/index.php/ejmed/article/view/1036 <div> <p class="Text"><span lang="EN-US">A congenital cyanotic heart defect such as Truncus Arteriosus (TA) is rare and is represented by a single arterial trunk that develops from the heart and gives rise to the pulmonary trunk in several manners. TA comprises 0.7% of all complex congenital heart malformations caused by numerous aetiologies, with the majority being genetic in origin. This malformation can be recognised in the prenatal period so that further medical intervention can be advocated. There are four types of the defect based on the Collett-Edwards classification. Type 4 is a rare form in which the pulmonary arteries are non-existent. Therefore, the lungs are supplied by major aortopulmonary collateral arteries. It may also describe this anatomical picture as pulmonary atresia with VSD. We report here a unique case of truncus arteriosus type 4 in an apparently well-thriving and acyanotic 6-month-old male infant. The deceased was presented with a brief history of inconsolable cry shortly before his demise and the underlying cardiac abnormalities were discovered at autopsy. A meticulous post-mortem examination elucidates a better diagnosis approach. Genetic counselling can be offered to parents in recurrent cases, such as cases of consanguinity.</span></p> </div> Nadiawati Razak, Lee Jiun Yih, Khairul Anuar Zainun Copyright (c) 2021 Nadiawati Razak, Lee Jiun Yih, Khairul Anuar Zainun http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1036 Thu, 07 Oct 2021 00:00:00 -0400 Congenital Cyst and Fistula of the Dorsum of the Nose: A Case Report and Literature Review https://ej-med.org/index.php/ejmed/article/view/1001 <div> <p class="Text"><span lang="EN-US">Congenital cyst and fistula of the dorsum of the nose is a rare congenital entity. We report a new case of dorsum nasal fistula in a 5 years old male patient that communicates the frontal region with the subcutaneous surface. Radiologic imaging showed a median 5mm defect, in the projection of the metopic suture that leads to a communication between the frontal region and the skin figure. Complete resection was performed by an external approach with vertical incision of the cyst. The histological diagnosis was consistent with a dermoid fistulized cyst. The follow-up displayed unremarkable finding, the patient did not present any diplopia nor decreased visual acuity, or any signs of meningitis or cerebrospinal fluid rhinorrhoea, or saddle nose.</span></p> </div> O. Benhoummad, F. E. Rizkou, S. Salhi, Y. Rochdi , A. Raji Copyright (c) 2021 O. Benhoummad, F. E. Rizkou, S. Salhi, Y. Rochdi , A. Raji http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1001 Mon, 13 Sep 2021 00:00:00 -0400 The Child's Craniopharyngiomas About 11 Cases and Review of the Literature https://ej-med.org/index.php/ejmed/article/view/1045 <div> <p class="Text"><span lang="EN-US">Craniopharyngioma is a benign and rare intracranial tumor. In children, the clinic is characterized by the semiological, neurological, ophthalmological, and endocrine tripod. Medical imaging, represented by computed tomography (CT) and especially magnetic resonance imaging (MRI), has revolutionized the approach to the diagnosis of the latter. It has a slow evolution and likely to recur late. Thus, prolonged clinical-radiological follow-up is important to affirm a cure. The aim of this study is to highlight the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of craniopharyngiomas in children. This work consisted of a retrospective study of 11 pediatric cases of this tumor collected in the Neurosurgery Department of the IBN ROCHD University Hospital in Casablanca between January 2011 and January 2017. In this series, the child's craniopharyngiomas accounted for a rate of 45.8% of all these tumors. The average age of our patients was 9.09 years, with a sex ratio of 0.37. The average time to diagnose was 10 months. The picture was dominated by 100% visual disturbances, signs of intracranial hypertension at 63.63% and endocrine disorders at 36.36%. The lesion was intra and suprasellar seat in 91% of cases and suprasellar seat in 9%. Tumor size was less than 4cm in 54.53% of cases. Hydrocephalus is observed in 27.27% of cases. The fronto-pterrional modus operandi was the most used 72% of cases. Total exeresis was achieved in 9.1% of cases. Overall trends were favorable in 72% of cases without noting mortality. Tumor progressive recovery was observed in 9.1% of cases, but there were no recurrences. Given its location, the treatment of craniopharyngioma can lead to significant consequences in children affecting the long-term quality of life, hence the importance of post-operative follow-up and multidisciplinary management.</span></p> </div> T. Mesbahi, A. Rafiq, L. Panu, O. Jamal, A. Naja Copyright (c) 2021 T. Mesbahi, A. Rafiq, L. Panu, O. Jamal, A. Naja http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1045 Thu, 14 Oct 2021 00:00:00 -0400 Impact of Covid-19 on the Mental Health of Indians: A Case Study https://ej-med.org/index.php/ejmed/article/view/1062 <div> <p class="Text"><span lang="EN-US">The unprecedented episode of the Covid-19 pandemic has been a massive shock to individuals all across the globe. Overwhelmed healthcare conditions, stringent lockdowns and plummeting economies have been a huge blow, especially for low- and middle-income countries. In the first phase of the pandemic, India had performed relatively better than most of the other nations in its income strata. However, the second wave of the disease had severe impacts on healthcare as well as the economy. In this light, individuals residing within the country were faced with an uphill task of evading the virus and keeping their mental health intact. This paper takes a dig into the mental health of Indian residents during the second wave of the pandemic (May 2021) through an analysis of a collected sample. The sample consisted of 400 participants (59% males, 40.25% females; mean age=26 years). The DASS-21 index was used to assess the mental state of citizens amidst an ongoing nationwide lockdown. A significant association was obtained between Covid-19, depression and overall DASS index. Thus, the importance of addressing mental health issues during a prevailing pandemic has been identified, and subsequent policy recommendations have been prescribed.</span></p> </div> S. Gupta, S. Sengupta Copyright (c) 2021 S. Gupta, S. Sengupta http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1062 Tue, 12 Oct 2021 00:00:00 -0400 Treated with Hymen Sparing Surgery in Familial Imperforate Hymen https://ej-med.org/index.php/ejmed/article/view/1040 <p>Imperforate hymen is a rare congenital female genital tract obstructive pathology. Although It is generally sporadic and isolated, very rare familial occurrence cases have been published in the literature. We present a rare case of the familial occurrence of IH and its surgical treatment. This case was admitted to our clinic with chronic pelvic pain, difficulty urination and pelvic mass. After the gynecologic examination and ultrasound view, the diagnosis of IH was made.&nbsp; Her sister who two years older than she had been previously evaluated for amenorrhea and her sister had undergone surgical procedures for IH. Because of Hymen is an important symbol of virginity in family culture, hymen sparing surgery was performed. The familial occurrence of IH is a rare condition and very few reported cases in the literature. Hymenectomy can cause social retraction in cases therefore hymen sparing surgery is an important surgery, especially Muslim cultures.</p> M. Kaplanoglu Copyright (c) 2021 M. Kaplanoglu http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1040 Tue, 28 Sep 2021 00:00:00 -0400 Analysis of CTLA-4 -318C/T Polymorphism in Thalassemia Patients Transfused at the Casablanca Children's Hospital (Morocco) https://ej-med.org/index.php/ejmed/article/view/1054 <p>Red blood cells (RBC) alloimmunization is a delayed adverse transfusion reaction in thalassemia patients. The mechanisms behind the inhibition or tolerance of red blood cells are still poorly understood. Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) molecule is expressed on Treg -lymphocyte membrane and is an inhibitory molecule which plays the mediator role of peripheral tolerance and maintains tolerance to self-antigens. Recent studies have reported that defect in the CTLA-4 gene expression could affect its function and be involved in the development of various pathologies as autoimmune diseases and the outcome after Allogenic hematopoietic stem cell transplantation; indeed, the objective of our study is the search for the association of the CTLA-4 polymorphism with the susceptibility to red blood cells alloimmunizations. In this study we looked for the polymorphism of the CTLA-4 gene at the -318 C/T position in 35 β-thalassemic patients (15alloimmunized and 20 non alloimunized) followed at the children's hospital in Casablanca, and 20 healthy controls, by PCR-RFLP and Sanger sequencing. In our cohort, none of the group cases revealed the mutation carried out by PCR RFLP. Indeed, this result was confirmed by Sanger sequencing. This study does not find an association of -318C/T SNPs in CTLA-4 gene and RBC alloimmunization among our cohort. Following these preliminary results, an investigation of the other exons of the CTLA-4 gene on a large cohort is necessary to complete this study.</p> Samira El Kababi, Bouchra El Khalfi, Khadija El Maani, Abdelaziz Soukri Copyright (c) 2021 Dr Samira EL Kababi, Pr Bouchra EL Khalfi, Pr Khadija EL Maani, Pr Abdelaziz Soukri http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1054 Thu, 30 Sep 2021 00:00:00 -0400 Laparoscopic Deroofing and Excision of a Large Left Renal Cyst Mimicking Chest Infection: Case Report https://ej-med.org/index.php/ejmed/article/view/1046 <div> <p class="Text"><span lang="EN-US"><em>Background: </em>The routine use of abdominal ultrasonography and computed tomography scan has increased the detection of asymptomatic renal cysts. Laparoscopy is usually suitable for treating large symptomatic renal cysts. </span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Objective:</em> To report a case of laparoscopic treatment of a man with large left renal cyst mimicking chest infection. </span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Case presentation: </em>A 75-year-old man, known hypertensive who had empirical treatment for chest infection without resolution of symptoms of cough and chest pain. He was on treatment for storage and voiding lower urinary tract symptoms with 10mg alfuzocin. Abdominal ultrasound and computed tomography scan confirmed a large left renal cortical cyst that measured 380mls. He subsequently had transperitoneal laparoscopic deroofing and excision of the renal cyst with operation finding of 300mls of straw coloured fluid excluding spillage. The immediate postoperative period was uneventful, and he was discharged home in a stable condition on the second day. The aspirate yielded no growth while the cytology report of cystic fluid was acute-on-chronic inflammation. Histology was reported as chronic pyelonephritis with cystic degeneration. </span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Conclusion:</em> Large renal cyst should be considered as differential diagnosis of unresolved chest infection and is safely treated by laparoscopic deroofing and excision.</span></p> </div> Augustine O. Takure, Sikiru A. Adebayo, Gabriel O. Ogun Copyright (c) 2021 Augustine O. Takure, Sikiru A. Adebayo, Gabriel O. Ogun http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1046 Thu, 07 Oct 2021 00:00:00 -0400 Distally Based Sural Flap in Children: Reliability Technique https://ej-med.org/index.php/ejmed/article/view/1015 <div> <p class="Text"><span lang="EN-US">The distally based sural flap often poses the problem of venous suffering that can lead to necrosis. We present a reconstruction of a loss of substance of the ankle in a 6 years old child, using a distal pedicle sural flap, made reliable by a racket like flap method, which reduces the risk of vascular complications and led to good integration of the flap, with a good functional result. Nevertheless, the aesthetic sequelae remain significant.</span></p> </div> A. Benjelloun, N. Belmoudden, M. Habla, M. Benkhaldoun, A. Elharti, M. Diouri Copyright (c) 2021 A. Benjelloun, N. Belmoudden, M. Habla, M. Benkhaldoun, A. Elharti, M. Diouri http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1015 Thu, 14 Oct 2021 00:00:00 -0400 Prevalence of Antimicrobial Resistance of Common Bacterial Isolates Before and During COVID-19 Pandemic in Armed Forces Hospital Jazan, Saudi Arabia https://ej-med.org/index.php/ejmed/article/view/1047 <div> <p class="Text"><span lang="EN-US"><em>Background:</em> Antimicrobial resistance (AMR) is one of the top global public health issues. After the pandemic of corona virus 2019 (COVID-19), AMR became a challenging complex that needs to be addressed during the corona pandemic.</span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Objectives:</em> Evaluating the prevalence of antimicrobial resistance (AMR) before and during COVID-19 pandemic.</span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Methods:</em> This is a retrospective cross-sectional study that was conducted at Armed Forces Hospital Jazan, Saudi Arabia using positive cultures` results from microbiology department.</span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Results:</em> <em>Escherichia coli,</em> <em>Pseudomonas aeruginosa, Staphylococcus aureus </em>and <em>Klebsiella pneumoniae</em> were the most prevalent microorganisms isolated from the patients. <em>E. coli</em> was the most isolated organism from patients with infections such as: COVID-19 fever, sepsis, urinary tract infections and wound infection. There was no significant change between 2019 and 2020 regarding AMR prevalence. </span></p> </div> <div> <p class="Text"><span lang="EN-US"><em>Conclusion:</em> There was no significant difference in the AMR before and during the COVID-19 era thus other large population studies must be conducted to evaluate worldwide evolution of AMR during COVID-19 pandemic.</span></p> </div> Manal AlDiba, Ahmad Mohammad Hassan Daghriri, Essa Mohammed Essa Jamali, Ahmed Alzahrani, Ahmed Bijad Alsharif, Haider Ghalip Almudeer, Hassan Khobrani, Nabil Turki Madhi Hakami, Wagih Mommtaz Ghannam, Hassan Mohamed Alasy Copyright (c) 2021 Manal AlDiba, Ahmad Mohammad Hassan Daghriri, Essa Mohammed Essa Jamali, Ahmed Alzahrani, Ahmed Bijad Alsharif, Haider Ghalip Almudeer, Hassan Khobrani, Nabil Turki Madhi Hakami, Wagih Mommtaz Ghannam, Hassan Mohamed Alasy http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1047 Wed, 29 Sep 2021 00:00:00 -0400 How Fast Foods Impact Coronary Artery Disease Incidence: A Cross-Sectional Study https://ej-med.org/index.php/ejmed/article/view/1033 <p>Coronary artery disease (CAD) is a very ordinary health problem around the globe. CAD is affected by numerous factors like diabetes, obesity, smoking, gender, and diet. However, the association of CAD with diet is understudied in our region that’s why our study was aimed to evaluate the effect of diet on CAD incidence. This cross-sectional study was completed among local population of Rawalpindi, Pakistan in almost 6 months from November 2020 to April 2021. People were taken in our study via set criteria. Data was collected by self-structured proforma. Data analysis was performed by applying IBM SPSS version 25. Descriptive statistics were applied for quantitative variables. Statistical tests like Chi-square test and Spearman correlation analysis were applied to know the association, direction, and strength of study variables. Our current study displays overall high prevalence CAD (17.48%) among study population. Mean value of age for study participants was 45.42 with SD of ±8.01years. Prevalence of CAD was more common among females, faster food eaters and fresh fruit and raw vegetables non-eaters. Gender, fast food, and fresh fruits and vegetables were associated with CHD significantly with p-values 0.030, 0.0007, and 0.0006 respectively. Strength and direction for fast food and CAD association was very strong and positive while for association between fresh fruits and raw vegetables and CAD was very strong and negative with correlation coefficient +0.812 and -0.831 respectively. In a nutshell, current study indicates high prevalence of CAD especially among females, fast food eaters and fresh fruits and raw vegetables non-eaters. Higher consumption of fast foods leads to higher incidence of CAD and vice versa while higher consumption of fresh fruits and raw vegetables bring down the incidence of CAD incidence and vice versa. So, we need to create awareness among people about the impact of food on CAD and gender specific interventions for each gender to lower down the CAD incidence.</p> Khudayenoor, Ayesha Shaheen, Aimen Fatima, Zohaib Saleem, Hafeez Arshad, Tayyab Mumtaz Khan, Shahrukh Khan, Bilal Sharif, Madeeha Mumtaz Copyright (c) 2021 Khudayenoor, A. Shaheen, A. Fatima, Z. Saleem, H. Arshad, T. M. Khan, S. Khan, B. Sharif, M. Mumtaz http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1033 Thu, 14 Oct 2021 00:00:00 -0400 The Eye with Ears – A Symbol-Based Aid in Medical Teaching https://ej-med.org/index.php/ejmed/article/view/977 <p>Visual clinical examination forms the diagnostic basis in skin-related conditions and is an essential element in medical teaching. The author describes a symbol-based aid to explain the dichotomy of factual observed findings with the information based on medical history: The Eye with Ears. It represents the two most relevant aspects in clinical examination of skin-related conditions and helps to clarify the contrast between the actual observation with information based on the context or past medical history. With the described aid, the author believes to have improved the quality of the teaching in clinical examination and that it has functioned as a practical help for medical students’ and residents’ professional development.</p> Alexander Salava Copyright (c) 2021 Alexander Salava http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/977 Tue, 21 Sep 2021 00:00:00 -0400 How Combining Grounding and Acupuncture Simultaneously Increases Beneficial Outcomes Over Traditional Acupuncture? https://ej-med.org/index.php/ejmed/article/view/1025 <div> <p class="Text"><span lang="EN-US">Multidisciplinary studies showed that when the human body is electrically in contact with the Earth (earthing or grounding), it produces intriguing consequences on the physiology and health of the human being. These effects are related to treating acute and chronic inflammatory and autoimmune illnesses, immunological responses, wound treatment, and prevention. At the same time, acupuncture in Traditional Medicine has been widely utilized for its low side effects and therapeutic effectiveness as primary therapeutic therapy. However, the electrical reaction to acupuncture stimulation has not been investigated in conditions with acupuncture that could alter acupuncture therapeutic effectiveness. The study's objective is to inform scientists of the apparent innovative approach to inflammation studies; and alert researchers to the importance of the duration and the degree of grounding, which may affect the results of inflammation, injury, and tumorigenesis studies. Grounding with acupuncture decreases pain and changes the quantity of circulating neutrophils and lymphocytes and circulating chemical substances linked to inflammation. This work reviews the potential of acupuncture with earthing as an easy and readily accessible worldwide modality of substantial clinical importance is reviewed in this work.</span></p> </div> Madiha Khalid, Jeremy Madvin Copyright (c) 2021 Jeremy Madvin, Madiha Khalid http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1025 Thu, 23 Sep 2021 00:00:00 -0400 Assessment of Stress Level of Young Undergraduates Before and After a Degree Examination Using Heart Rate Variability Analysis https://ej-med.org/index.php/ejmed/article/view/1008 <p>This study aimed at assessing the value of heart rate variability (HRV) as a stress indicator before and after a final re-sit exam among healthy sixth grade medical students. Fifty participants were recruited for the study (test group, n = 30; control group, n = 20). Each participant was examined for 5 minutes pre and post exam periods using the Heartmath proprietary protocol. EmWave equipment was used to detect, record and analyze the HR and to plot out the variability in discrete percentages for low, medium and high coherences. Results indicated that mean percentage coherence score was significantly higher in the test group (p &lt; 0.05) at low cardiac coherence domain, but lower (p &lt; 0.05) at the high coherence domain, compared with the control. Coherence score was significantly higher (p &lt; 0.05) after the exam indicating release from stress, as compared to before the examination when stress was observable among the exam candidates. There were no significant gender differences observed in cardiac coherence scores before and after examination. Our findings indicate that HRV is a reliable indicator of real-time exam stress and supports future clinical use of HRV as a non-invasive and simple stress test.</p> A. Obi, E. O. Nwobodo, U. Dimkpa, S. O. Maduka, E. Fintan Copyright (c) 2021 A. Obi, E. O. Nwobodo, U. Dimkpa, S. O. Maduka, E. Fintan http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1008 Tue, 14 Sep 2021 00:00:00 -0400 Anterior Segment Examination with Slit-Lamp Biomicroscope: What Should be Highlighted? https://ej-med.org/index.php/ejmed/article/view/1021 <div> <p class="Text"><span lang="EN-US">Ocular health assessment consists of various types of examinations that aim to find pathological conditions in the eye so that it helps ophthalmologists to diagnose and provide therapy for ocular disorders suffered by the patients. Slit-lamp biomicroscope is one of the most important eye assessments and has become the standard in assessing the pathological condition of the anterior part of the eye. This examination is performed using a stereoscopic biomicroscope instrument in combination with a bright illumination source. The results of the anterior segment examination using slit-lamp biomicroscope may provide more detailed ocular findings, such as the abnormalities of the eyelid, conjunctival lesions, abnormalities of the cornea, lens, or other parts of the anterior ocular segments. Therefore, the ability to examine slit-lamp biomicroscope is essential for the ophthalmologist. This review will discuss the eye examination using slit-lamp biomicroscope and the findings that will make it easier for clinicians to determine the direction of diagnostic approach in ocular patients. </span></p> </div> Fazella Kirara Sakti Copyright (c) 2021 Fazella Kirara Sakti http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1021 Wed, 22 Sep 2021 00:00:00 -0400 Association of Foods with Hypertension: A Call for Action https://ej-med.org/index.php/ejmed/article/view/1034 <p>Hypertension (HTN) is a very prevalent health issue around the world. Many factors influence HTN and some of those include diabetes, obesity, gender, age, and diet. Impact of diet on hypertension, is understudied in our region, therefore, this study was set to manifest the effect of diet on HTN prevalence. This cross-sectional study was performed among local Islamabad of population, Pakistan in 3 months from November 2019 to January 2020. 138 people were recruited in study via a developed criterion. Data was collected by self-designed proforma. Data analysis was done by applying IBM SPSS version 25. Descriptive statistics were used for quantitative variables. As data was non-parametric, so we applied non-parametric statistical tests like Mann Whitney test, Kruskal–Wallis test and Spearman correlation analysis were applied to assess, the difference in means of both systolic and diastolic BP between female and male, difference in means of both systolic and diastolic BP among three consumption frequency levels, and association, direction, and strength of between HTN and foods consumption. Present study indicates overall high prevalence of HTN (39.86%) among study population. Means of age, systolic and diastolic BP for study population were 43.42 (with SD of ±8.30) years, 138.01mmHg (with SD of ±19.37), and 89.38mmHg (with SD of ±7.10) respectively. Difference in means of both systolic and diastolic between females and males was not significant (p=0.093 and p=0.078 respectively) although these were higher among males and gender was not associated with HTN significantly (p=0.069). Strength and direction for association between fast food and HTN was strong and positive, for association between snack food and HTN was strong and positive while for association between fresh fruits and raw vegetables was strong and negative with correlation coefficients (+0.690 for diastolic, +0.710 for systolic), (+0.651 for diastolic, +0.661 for systolic), (-0.712 for diastolic, -0.712 for systolic) respectively. In short, present study concludes that HTN was more prevalent among males, fast food, snack foods eaters and fresh fruits and raw vegetables non-eater in contrast to females, fresh fruits and raw vegetables eaters and non-eaters of fast foods and snack foods. Higher consumption of fast foods and snack lead to higher prevalence of HTN and vice versa whereas higher consumption of fresh fruits and raw vegetables bring decline in the incidence of HTN incidence and vice versa. So, we are dependent on awareness among people about the influence of food on HTN and gender specific measures for each gender to reduce HTN incidence.</p> Khubaib Samdani, Faiz Rasool, Saad Azhar, Zarish Akhtar, Sarmad Hassan, Tayyab Mumtaz Khan, Sana Mansoor, Madeeha Mumtaz , Sharukh Khan Copyright (c) 2021 Khubaib Samdani, Faiz Rasool, Saad Azhar, Zarish Akhtar, Sarmad Hassan, Tayyab Mumtaz Khan, Sana Mansoor, Madeeha Mumtaz , Sharukh Khan http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1034 Fri, 15 Oct 2021 00:00:00 -0400 Male Partner Involvement in Promoting Antenatal Care and Skilled Delivery Attendance in Bumula Sub-County, Kenya https://ej-med.org/index.php/ejmed/article/view/978 <p>Globally, male partner involvement in antenatal care and skilled delivery services remains a challenge to effective management of maternal health. Maternal morbidities and mortalities have been increasing due to the underutilization of antenatal care and skilled delivery attendance at a global level. However, developed countries have had a different story on male partner involvement in antenatal care and skilled delivery attendance – most male partners are involved in the process. But sub-Saharan Africa in the global south records the highest percentage of male partners who are never active in accompanying their female counterparts to visit antenatal care and skilled delivery. In Kenya male involvement in maternal services remains low despite it being recognized as one of the pillars of safe motherhood. Therefore, this study was conducted to investigate male partner involvement in promoting antenatal care and skilled delivery attendance in Bumula Sub-County of Bungoma County in Kenya. It focused on the level of male partners involvement in maternal health. The study adopted a cross-sectional design. The target populations were married men and community health volunteers. The study had a sample size of 427 persons. Data was collected using a pre-tested semi-structured questionnaire, key in-depth interview guides, focused group discussion guides and observation checklist. Data were analysed using descriptive statistics with the aid of the Statistical Package for Social Scientist version 25. Data were presented using tables, figures, narratives and direct quotes. The study found a low level of male involvement (18%) in promoting antenatal care and skilled delivery attendance. Most of the male partners (83.1%) did not plan with their partners for ANC and skilled delivery services, however, (54.1%) accompanied their partners to the clinics. The study concluded There was a low level of male partner involvement in ANC and skilled delivery attendance. About 18% of male partners were involvement in ANC and skilled delivery attendance. There was an improvement of male partner involvement in accompaniment and provision of support. The study recommended that the two levels of government through the Ministry of Health should create awareness campaigns and public education with a targeted massage on negative cultural practices/mindset that hinder male partner involvement in maternal health services in the Bumula sub-county.</p> Rose A. M. Nyang’au, Maximilla Wanzala, Tom Were Copyright (c) 2021 Rose A. M. Nyang’au, Maximilla Wanzala, Tom Were http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/978 Thu, 14 Oct 2021 00:00:00 -0400 Prevalence of Extended-Spectrum β-Lactamase-Production among Clinical Gram-Negative Bacilli Isolates in A Tertiary Hospital, Southwest Nigeria https://ej-med.org/index.php/ejmed/article/view/1031 <div> <p class="Text"><span lang="EN-US">Extended spectrum β-lactamases (ESBLs) have emerged as important mechanisms of antimicrobial resistance to beta-lactam drugs in hospitals, thereby limiting the available treatment options for infections caused by these microorganisms. The objectives of this study were to determine the prevalence of ESBL production among clinical isolates of Gram-negative bacilli from Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria as part of the global efforts to provide information for the containment of the spread of antimicrobial resistance. This is a laboratory-based study of 186 consecutive non-duplicate Gram-negative bacilli (GNB) isolated from diverse clinical samples at the Microbiology laboratory of the hospital after standard aerobic cultures. The isolates were identified by conventional biochemical test scheme and commercial GNB API 20E identification kit. Antimicrobial susceptibility testing (AST) of each isolate was determined by the disk diffusion technique. Isolates presumptively identified as ESBL producers from the AST assay were confirmed by the combination disks method. Escherichia coli (n=43; 23.1%) predominated among the organisms, followed by Enterobacter spp (n=23; 12.4%) and Klebsiella spp (n=22; 11.8%). Most of the organisms (95.7%) were resistant to tetracycline and ampicillin, but the least resistance (4.3%) was exhibited to imipenem. Fifty-eight (31.2%) isolates were ESBL producers with a preponderance of E. coli (n=15; 25.9%). The ESBL producers were commonly isolated from urine samples (n=31; 53.4%), and were significantly more resistant to levofloxacin, ciprofloxacin, nalidixic acid, gentamicin, augmentin, cefepime, ceftriaxone, ceftazidime and cefotaxime (p&lt;0.05). This study has highlighted the therapeutic implications of the presence of EBSL in clinical isolates which was depicted by their multi-drug resistance phenotypes, thus emphasizing the need for continuous surveillance of bacterial resistance, institution of antimicrobial resistance stewardship in our hospital and regular screening of ESBLs in clinical isolates to prevent treatment failure.</span></p> </div> Babatunde Odetoyin, Oluwaseun Adewole Copyright (c) 2021 Babatunde Odetoyin, Oluwaseun Adewole http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1031 Tue, 21 Sep 2021 00:00:00 -0400 Practical Review of Diagnosis and Management of Cutaneous Tuberculosis in Indonesia https://ej-med.org/index.php/ejmed/article/view/1042 <div> <p class="Text"><span lang="EN-US">Tuberculosis is a life-threatening infectious disease that remains a high incidence worldwide. The classification of tuberculosis can be divided into two forms, i.e., pulmonary and extrapulmonary. The pathogenesis of tuberculosis depends on the cell-mediated immunity of the host. One of the variants of extrapulmonary tuberculosis is cutaneous tuberculosis, that commonly found in Indonesia. Based on the bacterial load, cutaneous tuberculosis is divided into two types, multibacillary and paucibacillary tuberculosis. Diagnosis of cutaneous tuberculosis often requires specific investigations, such as histopathology, Ziehl-Neelsen staining, Interferon-Gamma Release Assays, enzyme-linked immunosorbent assay serology, and Polymerase Chain Reaction. The treatment principle for cutaneous tuberculosis is the same as the treatment for pulmonary tuberculosis, which consists of an intensive and maintenance phase.</span></p> </div> Tiffany Roelan Copyright (c) 2021 Tiffany Roelan http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1042 Mon, 27 Sep 2021 00:00:00 -0400 Spinal Dural Arteriovenous Fistulas (FAVDR) with Peri- Medullary Venous Drainage: Clinical, Radiological and Therapeutic Aspects (Case Report and Literature Review) https://ej-med.org/index.php/ejmed/article/view/1056 <p>Spinal dural arteriovenous fistulas are rare and often unrecognized, they occur predominantly in men, with an initial clinical picture most often misleading made of chronic myelopathy in the absence of treatment, the evolution is <span style="font-size: 0.875rem;">slowly towards a definitive paraplegia. We report the case of a patient referred for a table of spinal cord compression revealing a spinal dural fistula with perimedullary venous drainage treated urgently, due to the worsening of the clinical picture. The standard treatment consists of surgical or endovascular exclusion of the fistula (in our case the fistula was surgically excluded). From this case and based on the literature, we will specify the a, clinical, radiological characteristics as well as the prognosis of these malformations, and we will discuss the possibilities of therapeutic management.</span></p> Tarek Mesbahi, Abderrahmane Rafiq, Nidal Amara, Marouane Makhchoune, Abdelhakim Lakhdar Copyright (c) 2021 Tarek Mesbahi, Abderrahmane Rafiq, Nidal Amara, Marouane Makhchoune, Abdelhakim Lakhdar http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1056 Tue, 12 Oct 2021 00:00:00 -0400 Level of Micronutrients Affects Pathophysiology of Diabetes Mellitus: A Scoping Review https://ej-med.org/index.php/ejmed/article/view/1019 <p>Currently, 463 million adults across the globe are living with diabetes. If undeterred, this figure is projected to rise to 700 million by 2045. About 79% of adult diabetics live in Africa; majority of whom are undiagnosed. Several interventions are already available, but the disease prevalence seems steady on an upward trajectory. The economic cost of managing diabetes is overwhelming considering that type II cases have overly and audaciously continues to rise. This underpins the need for exploration of more feasible and relatively inexpensive interventions. We profiled the role of micronutrients in the pathophysiology of diabetes mellitus (DM). Findings from 10 studies published in highly refereed journals and indexed in Research Gate, PubMed, and Elsevier were synthesized, collated, and reported. Guidelines such as year of publication, conflict of interest, type of journal, research design among others, informed the process of study selection. The level of Selenium (Se) and Copper (Cu) was higher when HBA1C was higher. Further, the level of Mg, P, K, &amp; Vitamin D correlated inversely with HBA1C. Some studies reported increased levels of Zinc (Zn) in DM subjects while others reported a decrease. Diabetes mellitus subjects should reduce intake of Se and Cu and increase intake of Mg, P, K, &amp; Vitamin D.</p> Dominic Kiprotich, Nourine C. Yegon, Michael N. Walekhwa Copyright (c) 2021 Dominic Kiprotich, Nourine C. Yegon, Michael N. Walekhwa http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1019 Mon, 27 Sep 2021 00:00:00 -0400 Diagnosis and Management of Internal Hemorrhoids: A Brief Review https://ej-med.org/index.php/ejmed/article/view/1014 <p>Hemorrhoidal disease is a pathological condition due to the abnormal engorgement of the arteriovenous plexus beneath the anal mucosa. Anatomically, it can be located under the skin on the outer part of the dentate line, known as external hemorrhoid; or inside the anus on the proximal part of the dentate line, called internal hemorrhoid. Internal hemorrhoid may further develop from a painless anal mass into protruded and painful mass throughout the anal canal, often accompanied by inflammation and more severe symptoms. Various management strategies need to be considered carefully to ensure the success of therapy and improve the quality of life of patients with internal hemorrhoids. Conservative management is the initial stage that can be performed, including the provision of high-fiber nutrition, education related to bathroom habits, and the use of flavonoid regimens. Surgical therapy can be divided into outpatient intervention and conventional surgeries. This review will encompass the comprehensive diagnostic approach and management of internal hemorrhoids to help clinicians understand the appropriate management and provide better clinical benefits for the patients.</p> Stephen William Soeseno, P. Agus Eka Wahyudi, Febyan Febyan Copyright (c) 2021 Stephen William Soeseno, P. Agus Eka Wahyudi, Febyan Febyan http://creativecommons.org/licenses/by/4.0 https://ej-med.org/index.php/ejmed/article/view/1014 Mon, 06 Sep 2021 00:00:00 -0400