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El Mednifico Journal
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  This is an Open Access Journal Open Access journal
     ISSN (Print) 2307-7301
     Published by Mednifico Publishers Homepage  [1 journal]
  • Adherence to guidelines of healthy diet is low in patients with diabetes
           clinical inertia

    • Authors: Masoumeh Akhlaghi, Fatemeh Hemmati
      Abstract: Background: Diabetes is one of the most prevalent metabolic disorders affecting 382 million people worldwide and 8.7% of Iranian population aged between 15 and 64 years. We investigated adherence to healthy diet guidelines in patients with diabetes clinical inertia.Methods: This cross-sectional observational study was performed on 200 patients with diabetes (mostly type 2 diabetes) involved in poor glycemic control. The patients were recruited from a Diabetes Care Clinic in Iran. Biographic and medical information was obtained by interview. A semi-quantitative food frequency questionnaire was used to estimate consumption of food items. Data on plasma glucose and lipids was obtained from patients’ dossiers in the clinic. Individuals were excluded if their laboratory tests had been carried out earlier than 3 months prior to the study.Results: Mean hemoglobin A1c (HbA1c) was 8.3 ± 1.9%, 62.7% of the patients had HbA1c ≥7.5%, and 88.5% had at least one form of dyslipidemia. Consumption of dairy, fruit, and vegetables was lower than dietary recommendations for healthy individuals in 55%, 54.5%, and 83%, respectively, but 72% consumed high-fiber breads. Among the investigated dietary factors only consumption of high-fiber breads was significantly associated with lower HbA1c (P=0.03). Consumption of none of dietary items was associated with low- and high-density lipoproteins, but there were significant associations between triglycerides and consumption of vegetables (P=0.004), fish (P=0.02), soy (P=0.02), vegetable oils (P=0.047), and high-fiber breads (P=0.04).Conclusion: The patients adhered poorly to the guidelines of healthy diet. However, even if following these guidelines is not effective in the control of hyperglycemia in patients with diabetes clinical inertia, it may help to attenuate hypertriglyceridemia.
      PubDate: 2014-08-07
      Issue No: Vol. 2 (2014)
       
  • Effect of pesticides on color vision and anterior ocular structure of
           farmers

    • Authors: Sharanjeet Kaur, Azizan Izzah Azreena, Khang Nie Leong, Sumithira Narayanasamy
      Abstract: Background: Studies have shown that exposure to pesticides can affect ocular structure and color vision. The objectives of this study were to determine the incidence and effect of exposure on anterior ocular structure and color vision among farmers using pesticides in Cameron Highlands, Malaysia.Methods: Farmers in Cameron Highlands using pesticides that volunteered and fulfilled the inclusion criteria were recruited. A comprehensive optometric examination was conducted. Color vision was assessed using Ishihara plates, D-15 test and FM100Hue test under daylight illumination.Results: Seventy-four farmers of mean age 32.24 ± 1.23 years old were recruited. The only anterior ocular changes observed was bulbar conjunctival hyperemia with an incidence of 25.7%. The mean working hours was 8.83 ± 3.58 and the mean working years was 7.69 ± 8.35. Only 23% of farmers wore goggles to protect their eyes. The incidence of farmers with color vision defects was 5% using Ishihara Plates, 29% using D15 test and 49% using FM100Hue test. Majority of the color defects were of non-polar type. The mean total error score of the color vision defectives was 170.67 for the right eye and 163.81 for the left eye. There was a significant correlation between the duration of working hours (r=0.46, p=0.000) with the total error score.Conclusion: Exposure to pesticides can cause hyperemia and color vision defects in farmers and the severity correlates highly with exposure duration for color vision defects.
      PubDate: 2014-08-07
      Issue No: Vol. 2 (2014)
       
  • The applicability of proprioceptive and endurance measurement protocols to
           treat patients with chronic non-specific neck pain

    • Authors: J Arami, A Rezasoltani, J Eghlidi, Z Ebrahimabadi, J Ylinen
      Abstract: Background: Neck pain constitutes a common disorder in modern societies. Numerous complications and episodes of recurrence have been observed with neck pain while few statistically evidence-based exercise protocols have been designed. The objective of this study was to detect and compare the applicability of two proprioceptive and endurance measurement protocols to treat patients with chronic non-specific neck pain.Methods: This was a single blinded, randomized clinical trial conducted at Mostapha Khomeini Hospital, Behbahan, Iran. Forty seven patients (16 males and 31 females) with chronic non-specific neck pain participated in this study. Subjects were randomized into two groups: endurance training and proprioceptive training. Each training was performed for ten subsequent days. A pressure biofeedback was used to measure the endurance of neck muscles and a laser resource device to measure the cervicocranial joint position error prior to therapy, on fifth, tenth sessions after the 1st day of treatment and 45 days after the last treatment day.Results: Significant differences were found between before and after therapy in terms of endurance index, joint position error, and pain measurments (p<0.05, p<0.01 and p<0.05) in both groups. After therapy, endurance index was significantly more pronounced in the endurance group, whereas the improvement in joint position error index was more pronounced in the proprioceptive group.Conclusion: The use of endurance and proprioceptive based measurement programs as was used in this study can be recommended to improve endurance, reduce proprioceptive error and pain in patients with chronic non-specific neck pain. Endurance exercise was a more efficient method for improving endurance and proprioceptive training was better in resolving joint position error and pain. Both protocols appeared to be applicable to treat patients with chronic non-specific neck pain.
      PubDate: 2014-08-07
      Issue No: Vol. 2 (2014)
       
  • The epidemiology of fractures around the elbow joint

    • Authors: Stuart A Aitken, Margaret M McQueen, Charles M Court-Brown
      Abstract: Background: The epidemiology of fractures of the distal humerus, proximal ulna and proximal radius has been individually studied. We sought to determine the epidemiological characteristics of all adult elbow fractures in our region, and look specifically for a relationship between their incidence and socioeconomic deprivation.Methods: We analyzed a prospectively collected trauma database from an institution serving a population of 545,000 adults. The demographic, injury and deprivation details for all patients suffering acute fractures of the distal humerus, proximal radius or proximal ulna were analyzed. Fractures were classified according to the AO, Mayo, Regan and Morrey, and modified Mason systems. Deprivation status was determined by using the Index of Multiple Deprivation.Results: We identified 405 elbow fractures in 382 patients, with an incidence of 7.4/10,000/yr. The incidence was higher in women, particularly in the elderly. In men the distribution was bimodal. Distal humerus, proximal ulna and proximal radius fractures displayed distinct epidemiological characteristics. A correlation was identified between increasing proximal forearm fracture incidence with increasing levels of deprivation.Conclusion: This report documents the current age-related incidence of these injuries and adds to the growing body of evidence that socioeconomic status influences the rate and patterns of skeletal injury in adults. Future work should examine whether the epidemiological characteristics of these injuries continue to change as our population demographics evolve over time
      PubDate: 2014-08-06
      Issue No: Vol. 2 (2014)
       
  • Comparison of transcerebellar diameter in growth restricted and normal
           singleton fetuses for the assessment of gestational age: A case control
           study

    • Authors: Sumera Aziz Ali, Azrah Bano Khuwaja
      Abstract: Background: Intrauterine growth restriction (IUGR) is an important cause of perinatal mortality. Early diagnosis of IUGR babies is an essential component in the management of various complications. Recognition of IUGR begins with the assessment of gestational age. Multiple biometric parameters including transcerebellar diameter can be used to predict the gestational age. Whether transcerebellar diameter can be used similarly for assessing gestational age in normal and growth restricted fetuses needs to be determined in Pakistani population. Thus, this study was designed to measure and compare the transcerebellar diameter between normal and growth restricted fetuses among pregnant women presenting to a tertiary care hospital of Karachi.Methods: This was a case control study. Singleton fetuses with intrauterine growth retardation were identified as cases and all the singleton fetuses with normal growth were identified as controls. Logistic regression was used to analyze the data.Results: Mean transcerebellar diameter of normal fetuses group was 34.02±3.56 mm, while mean transcerebellar diameter of growth restricted fetuses group was 35.29±3.37 mm.  Moreover, no significant difference was found in transcerebellar diameter between normal and IUGR fetuses while adjusting for maternal age and parity (OR: 0.92, 95% CI: 0.813-1.041).Conclusion: Transcerebellar diameter was found to be same between normal and growth restricted fetuses. Therefore this parameter can be used as one of the important tools in assessing the gestational age in normal and growth restricted fetuses and can be helpful for obstetricians in appropriate management of various complications during pregnancy.
      PubDate: 2014-08-06
      Issue No: Vol. 2 (2014)
       
  • Role of ultrasound in determining small bowel intestinal obstruction:
           Findings at a public sector hospital of Pakistan

    • Authors: Zahid Ali Memon, Huzaifa Dawood, Muhammad Danish Saleem, Shaikh Hamizul Fawwad, Naheed Sultan
      Abstract: Background: Intestinal obstruction accounts for nearly 20% of surgical admissions for acute abdominal conditions. Keeping in view the wide array of etiological causes, prompt diagnosis of intestinal obstruction as the etiological cause behind acute abdominal pain is often difficult and deferred. In the present study, we evaluated the role of ultrasound in diagnosing intestinal obstruction of the small bowel in the setting of a public sector hospital of Karachi.Methods: This was a retrospective analysis of 150 patients who presented with small bowel obstruction at Civil Hospital, Karachi (June 2011 to June 2012). Those that underwent a pre-laparotomy abdominal ultrasound were included while mixed bowel obstruction or incomplete files were excluded. Ultrasound was used to identify the presence of obstruction, cause of obstruction, site of obstruction and presence of mass. All radiological findings were matched with surgical notes of laparotomy.Results: Abdominal ultrasound failed to detect mechanical obstruction in only 18.7% (n=28) cases (sensitivity 81.33%). However, ultrasound was not very effective in distinguishing the segment of bowel involved in obstruction in almost half the cases (56%). Ileo-jejunal loops were the most common site of obstruction as identified by ultrasound and later discovered upon laparotomy. The most common etiology reported was tuberculosis (30.7%), adhesions (24.7%), hernia (17.3%) and mass. Ultrasound detected mass as etiological cause in 14 out of 30 cases.Conclusion: Ultrasound is a cheap, safe and efficient mode of diagnosing mechanical intestinal obstruction involving small bowel in public sector hospitals.
      PubDate: 2014-08-05
      Issue No: Vol. 2 (2014)
       
  • Unmet need for contraception and unintended pregnancies among women of
           reproductive age group: A situation analysis

    • Authors: Sumera Aziz Ali, Savera Aziz Ali
      Abstract: Each year approximately 210 million pregnancies occur worldwide and more than one-third (75 to 80 million) of these are unintended, more than half of these (46 million) unintended pregnancies undergo unsafe abortions. In Pakistan 16% of the births are reported to be unwanted and if the unwanted fertility is eliminated, total fertility in Pakistan would be 3.1 births per woman. Total demand for family planning in Pakistan is 55%, while the contraceptive prevalence rate is 35% and unmet need for family planning is 20%. Reasons for unmet need and unintended pregnancy include lack of permission, fear of side effects, poor quality and limited access to family planning services. Moreover, non-use of contraceptive methods and method failure are important reasons for unintended pregnancy. Women of reproductive age experience multiple adverse outcomes due to unintended pregnancy. These women neither care for themselves nor for their family and due to such careless behavior the likelihood of maternal and neonatal morbidity and mortality increases. Research on intervention programs for unintended pregnancy needs to be done in future. It is important to focus on how intervention programs should be designed, delivered and examined. Intervention strategies should aim to reduce unintended pregnancy by focusing on all the identified factors so that infant and maternal mortality and morbidity as well as the need for abortion is decreased and the overall well-being of the family is maintained and enhanced. Thus, improved community efforts are required to educate women about family planning as well about the proper use of family planning methods. Improved counseling and proper follow up is required especially of those women who adopt any method. Since improper treatment, incomplete follow up and limited choice of method might lead the women to discontinue the methods, therefore role of quality of care of existing services in improving women’s ability to achieve their desired reproductive goals should be given an attention. In addition to improving the quality of existing family planning services, the focus should be on the follow up of women for assessing the adherence to method and addressing their problems related to any method.
      PubDate: 2014-08-05
      Issue No: Vol. 2 (2014)
       
  • The burden of malaria with historical perspective in Nigerian concept and
           world view

    • Authors: Olugbenga Adekunle Olowe, Rita A Olowe, O A Awa
      Abstract: Malaria is an infection of humans and other animals caused by eukaryotic organisms of the genus, Plasmodium. The protozoan first infects the liver, subsequently acts as a parasite within the system in the red blood cells, causing symptoms that typically include fever and headache, in severe cases progressing to coma and/or death. The disease is widespread in tropical and subtropical regions in a broad band around the equator, including much of sub-Sahara Africa, Asia and the United States of America with its attendant burden on drug and drug resistance. Four species of Plasmodium most commonly infect and can be transmitted by humans. Severe disease is largely caused by P. falciparum while the disease caused by P. vivax, P. ovale and P. malariae is generally a milder form that is rarely fatal. Malaria is prevalent in tropical regions because the significant amounts of rainfall, consistently high temperatures and high humidity, along with stagnant waters in which mosquito larvae readily mature, provide with the environment needed for continuous breeding. Disease transmission can be reduced by preventing mosquito bites, distribution and use of mosquito nets and insect repellents, or with mosquito-control measures such as spraying insecticides, prevention of bushy environment and draining stagnant water. The World Health Organization continues to work hard to reduce the burden of malaria in Nigeria and Africa as a whole.
      PubDate: 2014-08-05
      Issue No: Vol. 2 (2014)
       
  • Concomitant occurrence of fibrous dysplasia and epilepsy: Report of an
           unusual case

    • Authors: Amita Aditya, Manjushri Waingade
      Abstract: Background: Fibrous dysplasia (FD) is a developmental anomaly in which normal bone is gradually replaced with fibrous connective tissue. There are two variants: monostotic and polyostotic. The diagnosis of fibrous dysplasia is generally made on the basis of clinical and radiographic findings. The association between epilepsy and craniofacial fibrous dysplasia is rather unusual. A case of fibrous dysplasia is presented here which was seen co-existing with epileptic seizures.Case Presentation: An 18-year-old male patient reported to the department with the chief complaint of a painless swelling on the right side of the face since 4 years. He gave history of trauma secondary to a fall 4 years back and seizures since 2 years. On extra-oral examination, a diffuse swelling was seen on the right middle third of face extending medio-laterally from ala of nose to outer canthal line, superiorly involving the zygomatic arch. The swelling was bony hard and non-tender on palpation. Intra-orally, swelling was seen associated with right buccal vestibule extending from right lateral incisors to second molar region, with normal overlying surface. Based on the history and clinical presentation a provisional diagnosis of a benign lesion was made. Radiographic features were suggestive of a fibro-osseous lesion, most probably fibrous dysplasia. Considering the fact that fibrous dysplasia may sometimes lead to epilepsy, patient was referred for thorough neurological examination. A surgery was then planned for the patient for correction of the facial deformity. However, the patient refused any further treatment.Conclusion: A clinician must be vigilant and cognizant of this association so that a prompt referral and treatment may be achieved.
      PubDate: 2014-08-05
      Issue No: Vol. 2 (2014)
       
  • Multimodality imaging features of Poland syndrome associated with cervical
           rib and elongated transverse process of cervical vertebrae

    • Authors: Muammer Akyol, Onur Gokdemir, Tulin Ozturk
      Abstract: Background: Poland syndrome (PS) is a rare congenital anomaly characterized by partial or complete absence of the major pectoral muscle which is variably associated with ipsilateral thoracic and upper limb deformities.Case Presentation: We present multimodality imaging features of PS associated with cervical rib and elongated transverse process of cervical vertebrae in a 25 year-old female patient.Conclusion: PS is a rare congenital disorder that has a wide spectrum of clinical presentations. The aim of our case report was to show multimodality imaging features of the PS associated with cervical rib and elongated transverse process of cervical vertebrae. We could not find any similar case reported in the literature.
      PubDate: 2014-08-04
      Issue No: Vol. 2 (2014)
       
  • Dental management of severe early childhood caries

    • Authors: Gurusamy Kayalvizhi, T D Vishwas, R Mahantesh, Balaji Subramaniyan
      Abstract: Background: Early childhood caries (ECC) is the new term given to dental decay in infants and toddlers. Severe ECC (S-ECC) is the most devastating caries, which is typical and follows a definite pattern. It is diagnosed by its clinical appearance and history of the child’s nursing/dietary habits. This article focuses on complete oral rehabilitation of two S-ECC patients.Case Presentation: Case 1: A 4 year-old boy accompanied by his mother reported to our department with the chief complaint of pain in the lower left back tooth region. A diagnosis of S-ECC was made based on history, examination and radiographic findings. Preventive regimens were enforced starting with parent counseling regarding oral hygiene. Case 2: A 6-year-old girl reported to our department with the chief complaint of masticatory difficulty and food lodgment in the upper right and left back tooth region. With detailed history and examination, a diagnosis of S-ECC was made. Again management was started by enforcing preventive treatment protocols with diet counseling, oral hygiene and brushing instructions, use of fluoridated tooth paste and professional acidulated phosphate fluoride application.Conclusion: Successful dental treatment for S-ECC can be rendered if the parents and the child are motivated and counselled. Treatment should be aimed at modifying all the four factors in caries tetralogy. Because of its aggressive nature, treatment should be specific for each individual patient.
      PubDate: 2014-08-04
      Issue No: Vol. 2 (2014)
       
  • Giant unilocular hydatid cyst of spleen

    • Authors: Shahbaz Habib Faridi, Bushra Siddiqui, Mohammad Aslam
      Abstract: Background: Hydatid cyst of spleen is a very rare condition. It is usually secondary to spread of cysts from other regions. Primary hydatid cyst of spleen without involvement of any other organ is even rarer. Here, we report a case of a giant unilocular hydatid cyst of spleen without involvement of any other organ. The patient underwent laparotomy and splenectomy was done. This case report aims at reporting a rare case of a primary giant unilocular hydatid cyst of spleen and describes its management.Case Presentation: A 45 year old female presented to the surgical outpatient department with complaint of fever, dull dragging ache and lump in the left upper abdomen. On examination there was a slightly tender lump in the left hypochondrium suggestive of splenomegaly. Ultrasonography and computed tomography of abdomen were suggestive of a giant unilocular splenic hydatid cyst. The patient was operated and splenectomy was performed. The patient was discharged on albendazole therapy and the follow-up was uneventful. Histopathological examination of the specimen confirmed the presence of hydatid cyst.Conclusion: Primary hydatid cyst of spleen is a very rare condition. Surgery remains the mainstay of treatment. The evolving concept is towards splenic preservation surgery with cyst enucleation to prevent overwhelming post-splenectomy infections.
      PubDate: 2014-08-04
      Issue No: Vol. 2 (2014)
       
  • A case of Stevens-Johnson syndrome

    • Authors: S V S G Nirmala, R Dadeepya, V Lalitha, N Sivakumar, C Sandeep
      Abstract: Background: Stevens-Johnson syndrome (SJS) is an acute self-limited disease. The incidence of this disease is low, but there is a significant impact on child as well as parents because of its extensive involvement of the body. This paper reports a case of SJS in an eight year old male child along with the clinical features and treatment options.Case Presentation: A male child of 8 years was referred with the chief complaint of ulcers in the mouth since 3 days. Past medical history revealed severe drug reaction one month back, for which the patient attended a pediatric hospital elsewhere, where it was diagnosed as Steven-Johnson Syndrome and the treatment was given for the same. After one month of treatment, the child was referred to our department because of the persisting oral ulcers. On extra oral examination, skin lesions were healed whereas intra-oral examination revealed multiple painful ulcers on upper and lower labial mucosa, with accompanying painful cervical lymphadenopathy. The treatment consisted of topical application of hexigel and multivitamin supplements were prescribed. On follow up after 15 days, examination showed healed ulcers. The patient fully recovered within a month.Conclusion: Symptomatic management of the oral lesions is necessary in order to enable the patient to have oral feeds to maintain nutritional balance.
      PubDate: 2014-08-04
      Issue No: Vol. 2 (2014)
       
  • Traumatic asphyxial deaths

    • Authors: G N Pramod Kumar, B Manjunatha, Smitha Rani, B M Balaraj, Y P Raghavendra Babu
      Abstract: Asphyxial deaths are commonly encountered in forensic practice; however deaths due to traumatic asphyxia are uncommon. Traumatic asphyxia is a type of asphyxia where death results from mechanical compression of the chest and/or abdomen. Four cases of accidental traumatic asphyxia in pre-adolescent and adolescent age group are reported and discussed.
      PubDate: 2014-08-04
      Issue No: Vol. 2 (2014)
       
  • A fatal situation: Diabetes insipidus and superimposed acute polyuric
           kidney injury

    • Authors: Sena Memnune Ulu, Mehmet Polat, Abdullah Altug, Seref Yuksel
      Abstract: Diabetes insipidus occurs as a result of lack of secretion or activity of antidiuretic hormone. Polyuria may occur during acute kidney injury follow-up period. Until now, these two diseases in which monitoring and replacement of fluid and electrolyte are crucial, have not been reported together. In this report, a fatal situation, central diabetes insipidus and superimposed acute polyuric kidney injury is presented.
      PubDate: 2014-08-04
      Issue No: Vol. 2 (2014)
       
  • Kidney transplantation from a donor with nutcracker syndrome

    • Authors: Cem Tugmen, Eyup Kebapci, Ismail Sert, Mehmet Tanrisev, Hülya Colak, Yeliz Pekcevik, Sait Murat Dogan, Mustafa Olmez, Cezmi Karaca
      Abstract: Background: Nutcracker Syndrome (NCS) is a rarely encountered clinical condition. In NCS, due to the compression of the left renal vein between aorta and superior mesenteric artery, outflow of the left renal vein is impaired. It may occur with the symptoms like hematuria, proteinuria, pain on the left lumber, lower abdomen, varicocele and pelvic congestion or asymptomatic. In suspected cases, the diagnosis can be established by the radiological imaging.Case Presentation: In this case report, a 31 year old female who was referred to a live kidney donor diagnosed with NCS during preoperative evaluation is described. Transplantation process and post-transplantation course have been discussed according to literature. This case report is unique due to being the first report describing allogeneic kidney transplantation performed from a donor with NCS.Conclusion: In nutcracker syndrome, surgical treatment is recommended for the patients with serious symptoms. Surgical interventions and stenting are treatment modalities and this article suggests a new approach. It may be meaningful in terms of reporting the first successful allogeneic transplantation performed from a donor with NCS.
      PubDate: 2014-08-03
      Issue No: Vol. 2 (2014)
       
  • Merkel cell carcinoma of the head and neck: A case presentation in the
           light of literature

    • Authors: Feryal Karaca, Ferhat Ozden, Fatma Sert
      Abstract: Background: Merkel cell carcinoma of skin is seen mostly in elderly Caucasians. Mortality and morbidity is very high. Treatment of these cases is also quite difficult. Recommended treatment is primary total excision, sentinel lymph node dissection after sentinel lymph node sampling and adding radiotherapy or chemotherapy according to stage.Case Presentation: A 35 year old female patient had surgery because of an unhealed wound on the right ear. After giving adjuvant curative radiotherapy the patient had been followed for 18 months. After 18 months of follow up, Merkel cell carcinoma metastasis was detected and para-aortic metastatic mass was resected. The patient is being considered for chemotherapy.Conclusion: Merkel cell carcinoma is an aggressive malignancy observed mostly in elderly Caucasians. Management consists of surgery with adjuvant chemotherapy and/or radiotherapy in accordance with the stage.
      PubDate: 2014-08-03
      Issue No: Vol. 2 (2014)
       
  • Clinical and echocardiographic study of patients in heart failure with a
           normal/near normal ejection fraction

    • Authors: Asif Hasan, Muhammad Uwais Ashraf, Nazih Ahmad C L, Anjum Parvez
      Abstract: Background: Heart failure affects more than twenty million people worldwide. Epidemiological studies have shown that approximately one-half of the patients who develop heart failure have a normal or near normal ejection fraction. The diagnosis of heart failure with a normal ejection fraction (HFNEF) is difficult as compared to those with reduced ejection fraction, and so is the treatment. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods. It affects primarily the elderly individuals with co-morbidities such as hypertension, diabetes, obesity, renal dysfunction, atrial fibrillation etc. The aim of this research was to study the clinical and echocardiographic profile of patients in heart failure with a normal/near normal ejection fraction.Methods: This was a prospective, open-labeled, observational study conducted on 70 subjects. All patients with suspected heart failure, fulfilling the Framingham criteria were included in the study. Patients with a reduced ejection fraction (<40%) were excluded from the study. A detailed history, thorough medical examination and Doppler echocardiography were carried out on all the patients.  LVDD grade 1-4 was determined by detailed echocardiographic study (pulsed wave and tissue Doppler studies).Results: The mean age of patients was 64.84 ± 11.59 years. Maximum number of patients was observed in the 61-70 year age group. The majority of patients were females i.e. 38 out of 70 (54.3%). 36 patients were hypertensive (51.4%), 38 had a history of coronary artery disease (54.3%) and 21 patients had a history of diabetes mellitus (30%). 40% patients had a serum creatinine level of >1.2 mg%. Mean creatinine was 1.35 ± 0.65 mg%. 63% patients in the study group were anemic with a mean hemoglobin level of 11.3 ± 2.27 g%. 57% of the cases had HbA1c ≥ 5.7% of which, 28% had HbA1c in the pre-diabetic range. 16 patients (22.85%) had a history of atrial fibrillation. 22.8% patients had left ventricular diastolic dysfunction (LVDD) grade 1, 54.3% patients had LVDD grade 2, 20% has LVDD grade 3 and 2.85% had LVDD grad 4. 16 cases had a prolonged deceleration time (DT), with a mean DT of 225 ms. In cases of mild diastolic dysfunction due to impaired relaxation, IVRT was prolonged. Mean IVRT values in the LVDD grade 1 was 119 ms. The echocardiographic indices of restrictive cardiomyopathy showed an E/A ratio of >2.4 (mean 2.76) and E/e’ >15 (mean 17.51). IVRT was markedly reduced in patients with restrictive cardiomyopathy (mean IVRT was 51.09 ms).Conclusion: In the current study, we have seen that heart failure with normal or near normal ejection fraction is more common in females and in the elderly. Hypertension, diabetes mellitus, renal dysfunction, thyroid disorders and atrial fibrillation are associated commonly with HFNEF. Abnormal relaxation, pseudonormal filling pattern and restrictive filling are the mechanisms responsible for diastolic dysfunction.
      PubDate: 2014-08-02
      Issue No: Vol. 2 (2014)
       
  • Genital hygiene behaviors and associated factors in women living in rural
           areas of Turkey

    • Authors: Derya Adıbelli, Nur Özlem Kılınç, Yaşam Kemal Akpak, Dilek Kılıç
      Abstract: Background: In traditional societies, religious beliefs and cultural structure direct women more towards conventional behaviors and applications. This descriptive study was carried out with the purpose of determining the genital hygiene behaviors and associated factors in women living in rural areas.Methods: The sample of the study included 197 voluntary single and married women with age range from 20 to 49, registered at the Sarıkamış Erenler and Inönü Centers of Family Health in Turkey. The data was collected with a questionnaire form prepared according to the relevant literature and genital hygiene behavior inventory. The results were evaluated with one way analysis of variance, and Kruskal Wallis and Mann Whitney-U tests.Results: Most of the women used a vaginal douche (66%) and underwent no gynecologic control annually (57.9%). There were statistically significant differences in genital hygiene behaviors between women with regards to women’s education, marital status, profession/work, presence or absence of social security, income and husbands’ work and education (p<0.05). 50.3% changed underwear every day, 36.5% and 56.9% washed hands before and after changing menstrual pads, respectively, and 41.6% and 66.5% washed hands before and after using the toilet.Conclusion: Most of the women living in the rural used vaginal douche and had inferior standards of behavior related to genital hygiene. Nurses, as trainers and consultants, may help women particularly in rural areas for attaining good standards of reproductive health.
      PubDate: 2014-08-02
      Issue No: Vol. 2 (2014)
       
  • Collaborative care for schizophrenic patients in primary care: A double
           blind, randomized clinical trial of efficacy and safety

    • Authors: Saad Salman, Jawaria Idrees, Muhammad Anees, Mashaal Arifullah, Mansoor Al Waeel, Muhammad Ismail, Mehreen Hassan, Zahid Nazar
      Abstract: Background: Schizophrenia is one of the most severe psychiatric illnesses, with a prevalence of approximately 1% in the population. Pharmacists cooperate with the patient and other professionals in designing, implementing and monitoring a therapeutic plan and pharmacotherapy recommendations that will produce specific therapeutic outcomes for such patients. The objective of this study was to assess the role of clinical pharmacists’ involvement in Psychiatry ward for the treatment of schizophrenic patients.Methods: A double blind randomized control study was carried out in Psychiatry ward for a period of one year and three months at Lady Reading hospital, Khyber Pakhtunkhwa, Peshawar, Pakistan. Clinical response was determined in schizophrenic patients i.e. first episode psychosis, with objective rating scales, length of stay, adverse events, and patient compliance with the first clinic visit scheduled after discharge, and patient satisfaction on likert scale. Different scales were used to check the severity of positive, negative and general symptoms of the disorder, adherence to the medication and quality of life. Diary cards were given to the patients’ attendant so that they may remind their patient of their medication.Results: A total of 96 patients were enrolled in which 46 in control 50 in intervention groups. 3 patients in intervention group and 2 patients in control were under-diagnosed. We compared the outcomes of subjects treated in this collaborative care model, 46 in intervention group with 46 controlled group subjects receiving usual hospital care. After 6 months, the intervention group showed a significantly higher drug adherence rate than that of the control group. Morisky medication adherence scale (MMAS) and medication adherence report scale (MARS) showed p-value 0.006 and 0.001, respectively. The positive and negative syndrome scale (PANSS) showed p-value of 0.01 with change scores of -4.8 for intervention group. The SF-12 for quality of life (QOL) questionnaire showed p-value 0.002 in physical component summary (PCS), 0.001 in both mental component summary (MCS) and general health respectively. Patient satisfaction on likert scale showed a mean of 4.45 (SD=0.52) in the intervention group.Conclusion: Medication adherence and the quality of life of the schizophrenic patients were improved. Patients with co-morbidity were identified. Patient education and counseling regarding indication and medication adherence was helpful. Clinical improvement was noted in both groups, but the difference in intervened group was significant.
      PubDate: 2014-08-02
      Issue No: Vol. 2 (2014)
       
  • A comparative study of open tracheostomy and percutaneous tracheostomy in
           ICU setting

    • Authors: Bipin Kishore Prasad, Devjani Ghosh Shrestha
      Abstract: Background: The standard tracheostomy involves open standard dissection technique, established more than a hundred years ago. Alternative procedures like percutaneous tracheostomy (PCT) have evolved recently due to advance in technology and interest in minimally invasive procedures. A systematic randomized comparative cohort study was done with the aim to compare standard open tracheostomy with percutaneous tracheostomy techniques, namely serial guide wire dilating forceps (GWDF) and PercuTwist.Methods: This study was carried out in the Department of ENT and head and neck surgery in a tertiary referral medical center of Indian Army. The patients were followed up for one year post-decannulation or till their death due to medical morbidities. 45 adult patients in ICU, intubated and on prolonged mechanical ventilation, needing elective tracheostomy were included in the study. Pediatric cases, patients with distorted neck anatomy and those requiring emergency tracheostomy were excluded. 15 patients underwent standard open surgical tracheostomy. Amongst the other 30 cases, 15 percutaneous tracheostomy were done by guide wire dilating forceps technique and remaining 15 by PercuTwist.Results: Although the indications were limited and another surgeon was required to keep a watch through bronchoscope, it was observed that PCT was easier and quicker than open standard tracheostomy. It involved small incision and no dissection, less tissue trauma and better cosmetic result. Comparatively, the complication rate was also less.Conclusion: It can be concluded that training of surgeons and proper case selection makes percutaneous tracheostomy as good and safe as open technique.
      PubDate: 2014-08-01
      Issue No: Vol. 2 (2014)
       
  • Hepatocellular carcinoma: Could stem cell therapy ever be a viable
           solution'

    • Authors: Ahmer Irfan, Irfan Ahmer
      Abstract: Over the years, stem cells have always been believed to have great potential and may eventually be common use in the treatment of a variety of disease states. However, evidence of their use has only just started being collected and analyzed. We aim to review the evidence in medical literature for the use of stem cell therapy in hepatocellular carcinoma (HCC). The incidence of HCC has been increasing in the past 50 years, partly due to its association with cirrhosis. Current therapy has proved relatively ineffective and consequently there are no definitive treatment options. It is hoped that stem cell therapy may provide more effective results and may be carried forward as frontline therapy. Therefore, it is important to analyze the current evidence and to determine whether it supports clinical application of stem cell therapy. A through literature search was carried out on PubMed and Ovid Medline and cross referenced in January 2013 to determine all stem cell therapy trials in the treatment of liver disease. From this data, only those that focused on the treatment of HCC were included. Only two trials were found to study the effects of stem cell therapy in the treatment of HCC. Both trials extracted hematopoietic stem cells from the patients’ ileum. These were re-infused into the patient following portal vein embolization and liver regeneration noted. It was found that this therapy increased liver regeneration when compared to the placebo group. These positive results do not explain the lack of further research that has been carried out in this subject area and it would be impossible to draw valid conclusions on such a small evidence base. However, the increased interest in other disease states may suggest that stem cell therapy may provide more groundbreaking results and consequently the focus of research has shifted as such.
      PubDate: 2014-07-29
      Issue No: Vol. 2 (2014)
       
  • Munchausen syndrome presenting with recurrent abdominal pain and
           coagulation disorder

    • Authors: Hakan Demirci, Fatih Ermis, Zulfikar Polat, Murat Kantarcioglu, Ahmet Uygun, Sait Bagci
      Abstract: Munchausen syndrome is a serious psychiatric factitious disorder, or mental illness, wherein sufferers feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. In this attention-seeking syndrome associated with severe emotional difficulties, affected person repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms. The atypical manifestations of Munchausen syndrome represent a broad spectrum of clinical findings and features. It may be very difficult, labor intensive, expensive and time consuming to establish the accurate diagnosis. Herein, we report of a 28-year-old patient with coagulation disorder caused by self-inflicted warfarin use admitting repeatedly to many different hospitals with abdominal pain. Thorough psychiatric assessment and workup to shed light on the challenging clinical situation revealed the diagnosis of Munchausen syndrome for this patient.
      PubDate: 2014-07-28
      Issue No: Vol. 2 (2014)
       
  • Hybrid NOTES cholecystectomy - A safe and economic innovation

    • Authors: Momin Malik, Sherif Saleh, Irfan Ahmed
      Abstract: Background: Minimally invasive techniques have revolutionized surgery, making great impact in terms of reduced postoperative morbidity and shorter hospital stay by reducing abdominal wall trauma. Recent introduction of single incision laparoscopic surgery has introduced another debate. After establishing safety profile at the local level, we now present another modification of single incision cholecystectomy.Findings: These procedures were performed on two female patients diagnosed with gallstone disease and scheduled to undergo elective single incision laparoscopic surgery (SILS). Standard laparoscopic ports, straight laparoscopic instruments and 5mm 30° scopes were used. The scope was inserted per vaginum using a long 5mm laparoscopic port. The operation was performed using two instruments introduced through the umbilicus using two standard 5mm laparoscopic ports. The 5mm umbilical fascial defects did not require formal closure. No intra-operative or postoperative complication was reported. Operation was made technically easy because this modification provided greater flexibility of movement for operating instruments by decreasing crowding at the umbilical port without compromising on postoperative recovery or cosmetics.Conclusion: The use of laparoscope through vagina is a viable and safe modification of single incision laparoscopic surgery.
      PubDate: 2014-07-28
      Issue No: Vol. 2 (2014)
       
  • Renal transplant recipient undergoing cardiac surgery: Immunosuppressive
           management

    • Authors: Junsheng Mu, Xianshuai Li, Jianqun Zhang, Ping Bo
      Abstract: Cardiac surgery in renal transplant recipients has been become an important issue since it may have an impact on graft and patient survival. In addition, a renal transplant recipient usually needs to take long-term immunosuppressive medication, which would increase the risk and difficulty of cardiac surgical operation. We present a case of aortic valve replacement for quadricuspid aortic valve with regurgitation and stenosis in a renal transplant recipient. We also suggest a strategy to avoid organ rejection during the whole perioperative period.
      PubDate: 2014-07-27
      Issue No: Vol. 2 (2014)
       
  • Surgical approach in giant retrosternal goiter

    • Authors: Bipin Kishore Prasad, Rajnish Talwar, Manoj Kumar
      Abstract: Background: A retrosternal goiter occurs when thyroid enlarges downwards into the mediastinum. The natural history is of slow relentless increase in size causing airway compression, venous compression and swallowing problem. The management of a retrosternal goiter, symptomatic or asymptomatic and with or without suspicion of malignancy is surgical. Majority of benign retrosternal goiters can be delivered and resected through a standard neck incision. Rarely, however, some cases require additional thoracic access.Case Presentation: A case of giant dumbbell shaped benign retrosternal goiter meriting a planned median sternotomy is reported.Conclusion: Careful evaluation of CECT scan and a planned cervico-thoracic exposure in select cases ensures safe resection of the tumor avoiding major vascular catastrophe.
      PubDate: 2014-07-27
      Issue No: Vol. 2 (2014)
       
  • Successful conservative management in placenta previa percreta involving
           urinary bladder

    • Authors: Latika Sahu, Gouri Gandhi, Nalini Bala, Priyanka Thakur
      Abstract: Background: Placenta Previa Percreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accrete/percreta has been increased now and seems to parallel the increasing caesarean section (CS) rate.Case Presentation: This is a case of morbidly adherent placenta successfully managed conservatively. The patient was G3P2L2 with previous 2 lower segment caesarean sections (CS), antenatally diagnosed to be anterior placenta previa with placenta percreta. Elective classical CS followed by post op bilateral uterine artery embolization was done for this case. She required only 2 blood transfusions peri-operatively. The baby was fine. She required re-embolization after 5 weeks for hematuria due to bladder invasion of placenta percreta. Serum beta hCG value became normal after 18-20 weeks. She is doing well with normal menstrual cycle 1 year after classical caesarean section.Conclusion: Conservative management of placenta previa percreta, especially when involving bladder even if fertility preservation is not the concern, should be preferred over caesarean hysterectomy if facilities are available.
      PubDate: 2014-07-27
      Issue No: Vol. 2 (2014)
       
  • Phage therapy: The new old antibacterial therapy

    • Authors: Omar Anwar Elkadi
      Abstract: Phage therapy is a microbial based therapy that utilizes the lytic life cycle of bacteriophage to treat pathogenic bacterial infections. It is the earliest antibacterial therapy in modern history. The early success of phage therapy lost its luster after the development of the less controversial antibiotic chemotherapies. However, in the context of the advanced microbiology and biotechnology, phage therapy is reviving as an alternative for antibiotics chemotherapy, especially against multidrug resistant bacterial infections.
      PubDate: 2014-07-26
      Issue No: Vol. 2 (2014)
       
  • Oral health and pregnancy

    • Authors: Nida Zahid, Anna Ali
      Abstract: The progressive physiological changes that occur during pregnancy due to hormonal changes are necessary to support and safeguard the developing fetus and also to prepare the mother for parturition. But these systematic changes can also affect the female’s oral health causing deleterious effects on the quality of life of a female during pregnancy. Dental diseases such as deep dental caries, dental erosion, and periodontal infections can exacerbate during pregnancy. Moreover change in diet, nausea and vomiting during pregnancy deteriorates oral health and increases the chances of dental erosion and dental caries. Furthermore during labor and delivery, dislodged tooth and prostheses can cause complications. 
      PubDate: 2014-07-26
      Issue No: Vol. 2 (2014)
       
  • Integrated teaching in medical curriculum in India

    • Authors: Mohammed Abdul Hannan Hazari
      Abstract: The present medical curriculum utilizes a large part of the allotted time frame in the form of didactic theoretical lectures while little time is available for practical, clinical and behavioral skills acquisition which is required of a basic doctor. Curricular reforms and shift from traditional subject-based theoretical approach in a class room teaching to skill, competence and problem-based learning require appropriate mindset and capability on part of the teachers. Teachers need to adapt to the reforms for which appropriate training to be imparted to them.
      PubDate: 2014-07-26
      Issue No: Vol. 2 (2014)
       
  • Scope of the nutritional assessment in community and clinical settings

    • Authors: Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
      Abstract: The nutritional status of an individual is usually the result of multiple factors which interact with each other in different proportions. Acknowledging the role of diet in the onset of many diseases, assessment of the nutritional status of an individual/family/community is of extreme public health importance. The nutritional assessment is done with an aim to obtain specific information about the prevalence and geographic distribution of nutritional disorders in a given community/a specified population group, to identify nutritionally vulnerable high risk groups and to assess the role of different epidemiological factors in the natural history of the nutritional deficiency disorders. To conclude, the comprehensive nutritional assessment is an effective tool to assess the prevalence of nutritional disorders, to plan corrective measures and simultaneously evaluate the effectiveness of the implemented strategies.
      PubDate: 2014-07-26
      Issue No: Vol. 2 (2014)
       
  • What if the patient says “No!” in the ambulance: An ethical
           perspective for assessment of capacity in the prehospital emergency
           setting

    • Authors: Hasan Erbay
      Abstract: Is it a crucial problem for an emergency team that when a patient to whom an ambulance is called refuses emergency medical aid' In life-threatening situations, it is not only a realistic matter of life and death, but also an ethical challenge for prehospital emergency carers. It is impossible to contemplate and make recommendations in advance, for every possible situation that might arise in prehospital settings. Thinking about the ethical challenges that may be encountered, ahead of time is necessary to provide appropriate attitude.
      PubDate: 2014-07-26
      Issue No: Vol. 2 (2014)
       
  • Spatial information processing by the human visual system

    • Authors: Azadeh A Rikani, Zia Choudhry, Adnan Maqsood Choudhry, Nasir Rizvi, Huma Ikram
      Abstract: Ungerleider and Mishkin suggested the existence of two partly independent visual streams in mammalian visual system. According to their original account, a ventral stream originating from striate cortex and finally terminating in infer temporal region is responsible for identification of objects and, a dorsal stream also coming from striate cortex and projection to posterior parietal cortex plays an important role in localization of those same objects. “What versus Where” hypothesis has been center of investigators’ argument for years. In this review, considering extensive behavioral and neurophysiologic studies, some new ideas about processing of spatial information in mammalian visual system are briefly discussed.
      PubDate: 2014-07-25
      Issue No: Vol. 2 (2014)
       
  • Microinflammation as a candidate for diabetic nephropathy

    • Authors: Amal Abd El Hafez
      Abstract: Diabetic nephropathy (DN) is a major cause of mortality in patients with type 1 and 2 diabetes throughout the world. This review draws attention to the important role of microinflammation and the complex pathways implicated in the development and progression of DN. These pathways include the collaboration of metabolic, hemodynamic and hormonal factors with oxidative stress in patients with genetic susceptibility to create an inflammatory milieu. The key role of inflammatory cells in the kidney, particularly infiltrating macrophages and T-lymphocytes is highlighted. The major inflammatory cytokines and chemokines, receptors, adhesion molecules as well as transcription factors and transduction pathways involved in the pathogenesis of DN are also discussed. Understanding of these inflammatory pathways guides important therapeutic appliances and improves the discovery of new therapeutic targets that can be translated into clinical treatments for DN.
      PubDate: 2014-07-24
      Issue No: Vol. 2 (2014)
       
  • Antibiotic susceptibility pattern of Serratia marcescens isolates from
           wound infections in a tertiary health institution in Calabar, Nigeria

    • Authors: Ofonime Mark Ogba, Baki Idasa Mandor, Helena Martin Omang
      Abstract: Background: Serratia marcescens, a ubiquitous rod-shaped gram-negative bacterium is an opportunistic pathogen causing a plethora of nosocomial infections in humans including wound infections. They are identified in their ecological niches by their red pigment, prodigiosin. Information concerning these organisms in association with wound infections are sparse in our locality. This study was designed to determine the prevalence of Serratia marcescens in wound infections and their antimicrobial susceptibility profile.Findings: Wound swabs and pus were collected from the patients after receiving informed consent from them. Samples were inoculated on appropriate media and cultures were incubated at 37°C aerobically. Cultures were examined macroscopically and bacterial isolates were gram stained and microscopically examined. Pathogens were identified by their red pigment and other biochemical tests. The Kirby-Bauer disk diffusion method was used for antibiotic susceptibility testing. Out of the 251 wound samples collected during the study period, 25 (9.9%) were Serratia marcescens. Males [18 (72.0%)] were more susceptible than females [7 (28.0%)], but there was no influence of gender on the rates of infection (p=0.3). The susceptibility profile of the isolates to antibiotics tested ranged between 4% and 76%. The most sensitive antibiotic was levofloxacin [19 (76%)] followed by gentamicin [17 (68%)]. All the isolates were absolutely resistant to ampicillin.Conclusion: Fluoroquinolones have shown a good activity against Serratia marcescens and should be considered as a first line antibiotic against these infections in our locality. To stay ahead in the fight against these infections, effective infection control should be practiced, antibiotic usage should be optimized and empirical treatment reduced.
      PubDate: 2014-07-23
      Issue No: Vol. 2 (2014)
       
  • Dislodged feeding tubes: Should bedside x-rays be abandoned for advanced
           imaging'

    • Authors: Rachel G Eisenstadt, Rachel L Sensenig, Daniel N Holena, Carrie Sims, Benjamin Braslow, Jose L Pascual
      Abstract: Background: Feeding tube dislodgement is common and timely detection is important to prevent peritoneal contamination. It is unknown which imaging modality is preferable when tube dislodgement is suspected. We hypothesized that a bedside abdominal radiograph with contrast via the feeding tube (TS) would be inferior to non-bedside imaging.Methods: Current Procedural Terminology (CPT) codes involving repair/replacement of feeding tubes were queried at a tertiary care hospital from 2005-12. Demographics, laboratory results and operative records were queried to obtain case details. Radiological studies (TS, computed tomography [CT], fluoroscopy [FL]) obtained prior to laparotomy and time to surgery was evaluated.Results: Of 1451 emergency surgical operative cases during the study period, 37 were identified to be operations for dislodged tubes where 18 had tube removals only, two repairs, and 17 tube removals and replacements at an alternate site. Ten patients had no imaging prior to laparotomy. The remainder underwent TS (6), CT (18) and FL (3) as first line imaging. First line imaging with TS was associated with less subsequent operative contamination and a greater ability to maintain feeding access (p<0.05). Imaging correctly identified need for surgery in 71%, 90% and 66% for TS, CT and FL respectively.Conclusion: When feeding tube dislodgement is suspected, a bedside contrast tube study may not cause undue delays to the operating room or lead to worsened peritoneal contamination. CT as a first line test is not more expeditious and may be associated with worsened outcomes. Bedside tube studies are useful and often sufficient to lead directly to laparotomy.
      PubDate: 2014-07-22
      Issue No: Vol. 2 (2014)
       
  • Phytochemical screening and high performance thin layer chromatography
           finger printing analysis of green hull of Juglans regia (walnut)

    • Authors: Pardeep Sharma, Duraisamy Gomathi, Ganesan Ravikumar, Manokaran Kalaiselvi, Uma Chandrasekaran
      Abstract: Background: Medicinal plants are the richest bio-resource of drugs of traditional systems of medicine, modern medicines, nutraceuticals, food supplements, folk medicines, pharmaceutical intermediates and chemical entities for synthetic drugs. Therefore, researchers today are emphasizing on evaluation and characterization of various plants and plant constituents against a number of diseases. The aim of the study was to investigate the secondary metabolites and high performance thin layer chromatographic (HPTLC) finger printing of different extracts of Juglone regia.Methods: The secondary metabolites were analyzed for various extracts by using standard techniques and HPTLC method has also been established to study the presence of various flavonoids and phenolic compounds for different extracts of Juglone regia.Results: A preliminary phytochemical study confirmed the presence of active chemical constituents in the plant extract and the result showed a positive report for the presence of flavonoids, alkaloids and cardiac glycosides.Conclusion: These substances are known components of medicinal plants and may explain the use of the preparations of the herbs under study for managing a number of common ailments including dysentery, diabetes, hypertension and some microbial infections.
      PubDate: 2014-07-13
      Issue No: Vol. 2 (2014)
       
  • Audit of orthopedic trauma theatre usage: Observation from a secondary
           regional referral hospital in Oman

    • Authors: Dinesh Dhar
      Abstract: Background: Trauma is the leading cause of admission to our hospital and its unpredictability along with mismatch in demand and supply requires more use of resources and system streamlining. The operation theatre is described as the engine room of the hospital. There is no audit from Gulf region on the orthopedic operation theatre usage. The present study was undertaken to assess theatre utilization in our hospital and identify areas where improvement could be done which in turn can be applied to other surgical specialties in our hospital and beyond.Findings: This prospective audit was carried out in 303 bedded regional referral Nizwa hospital in the Department of Orthopedics. A total of 853 cases were electively operated upon during 12 months period from 1st January 2011 to 31st December 2011 in orthopedic operation theatre which was run for 261 days electively during that period. Cases performed on public holidays or during weekend and after 1400 hrs were excluded and classified as emergency procedures. The data was recorded from the time the patient entered the operation theatre (Enter OT) to the time he left (Exit OT). The data was recorded for surgery, anesthesia, changeover, total operating time respectively and calculations made for other variables. 632 cases (74%) started later than scheduled time with average of 22.8 min late start time. Delay in starting the list was due to late arrival of surgeons (22.2%) or anesthetist (28%) in 50.2% cases. Delay due to late or incomplete preparation of the patient or transportation of patient accounted for 44.4% cases. Other causes of delay such as physician or anesthesia review prior to surgery accounted for 5.4% of the delay.Conclusion: Operation theatre, being an area of maximum and complex activity in any hospital, needs multipronged strategy to improve its utilization continuously with regular theatre committee meetings to discuss and anticipate problems and chalk out new ideas and strategies.
      PubDate: 2014-04-03
      Issue No: Vol. 2 (2014)
       
 
 
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