Factors associated with community engagement in areas with high and low incidence of local malaria cases in Zanzibar

Introduction: the prevalence of asymptomatic infection in the general population in Zanzibar has declined from above 25% in 2005 to less than 1% in 2010. Despite these achievements, in 2021, the number of malaria cases increased by two folds. This study aimed at understanding the levels of community engagement towards malaria elimination and factors associated with them to provide recommendations that can be used to reinforce community engagement. Methods: a descriptive cross-sectional survey was conducted using structured questionnaires to 431 randomly selected households. The interviewees were the heads of households or representative adults above 18 years. Univariate and multivariate analysis was done to determine the association between social demographic characteristics, malaria knowledge, practicing malaria prevention interventions and status of community engagement. Statistical significance test was declared at P- value <0.05. Results: of all respondents, 261 (60.6%) were not engaged in either planning or implementation of malaria interventions, of which 120 (45.9%) participants were in the high malaria transmission and 141 (54.0%) from the low malaria transmission (P=0.018). Factors significantly associated with increased odds of community engagement were the level of knowledge on malaria (P= 0.002) and factors independently associated with reduced odds of community engagement was the level of malaria burden (P= 0.01). Conclusion: level of malaria knowledge and malaria burden were associated with community engagement. There is a need to increase malaria knowledge in the community based on the existing gaps as this study suggests that having high malaria knowledge can significantly contribute to increased opportunity for community engagement.

Removing barriers to healthcare through an intercultural healthcare system: Focus group evidence / 中西医结合学报

OBJECTIVE@#Barriers to healthcare in Ghana are multifaceted. Many people, including patients and providers, face them at different levels. To address these barriers, there is a need to explore the role of an intercultural healthcare system. This paper explores and provides the first evidence on ways through which an intercultural healthcare system can reduce the sociocultural and economic barriers to healthcare in Ghana.@*METHODS@#Focus group discussions with 35 participants comprising 17 healthcare users, 11 formal healthcare providers and 7 alternative healthcare providers were conducted to gather data. Thematic analyses were performed on the transcribed data and presented based on a posteriori inductive reduction approach.@*RESULTS@#Findings reveal that an intercultural healthcare system in Ghana can help reduce barriers to healthcare, especially cultural, social and economic barriers, by fostering an enhanced relationship between culture and healthcare, promoting affordable healthcare and promoting effective communication between healthcare providers and users. Weak institutional support, lack of strong political will and commitment, lack of training to meet standards of practice, poor registration and regulatory measures, and lack of universal acceptance inhibit implementation of an intercultural healthcare system in Ghana.@*CONCLUSION@#The support for intercultural healthcare system and the agreement on its perceived ability to reduce social, cultural and economic healthcare barriers for service users offer an opportunity for policymakers to demonstrate a stronger political will and improved commitment for effective education and training, enforcement of regulatory measures, inclusion of intercultural healthcare in medical school curricula across the country, and community engagement.

Improvement in body composition of adult postbariatric surgery patients at one-year follow-up at a public hospital in United Arab Emirates

@#Background: Data on postoperative follow-ups and bariatric surgery (BS) outcomes performed in the United Arab Emirates (UAE) are crucial for registry. This study assessed the one-year postoperative changes in body composition and metabolic profiles in BS patients. Methods: The medical and dietetics records of 51 adult patients who underwent BS in the largest public hospital in Sharjah, UAE were reviewed. Data on body weight and composition, as well as metabolic profile (blood glucose and lipid levels) from the initial until the last hospital visit were recorded. Results: The median (interquartile range) follow-up period was 6.0 (8.0) months. The patients had significant total weight loss [19.3 (12.6)%] and reduction in body mass index (BMI) [18.0 (13.6)%] of approximately 7 BMI points. Moreover, the patients’ body composition improved significantly; loss was the highest in fat mass [–30.9 (22.1)%] and the least in lean body mass [–8.6 (8.4)%]. There was a steady decline in all body composition variables with a longer duration of follow-up visits from 1–3 months to 10–12 months. The fat mass (–40.3%):lean body mass (–10.7%) loss ratio was 3.8:1 at 10–12 months. The patients’ metabolic status was normal during the last postoperative visit. Conclusions: Incremental improvements in body composition of patients were evident with longer follow-up visits up to one year after BS. Hence, patients should attend regular follow-up visits after BS. Moreover, accurate and complete documentations of medical and dietetics visits are mandated.

Magnetic Resonance Imaging in the Preoperative T Staging of Gastric Cancer (A Critical Appraisal)

Background:Gastric cancer accounts for many cancer-related deaths, is one of the top leading cause of cancer-associated mortality. Tumor staging and classification depends upon histological, immune histochemical tests along with the radiological imaging. In the preoperative T staging of gastric cancer, Magnetic Resonance Imaging (MRI) has become principal attention in recent years.Aim:Evaluating the accuracy of MRI in the preoperative T staging of gastric cancer vis-a-vis post-operative pathological staging Methods: A total of 37 patients were initially taken in our study, out of which 13 patients were excluded as they underwent neo adjuvant chemoradiotherapy for the down staging of the tumor. The 24 patients became the sample size of our study and their magnetic resonance imaging (MRI) T stage was correlated with pathological T-stage.Results:The diagnostic accuracy of T1stage by MRI was 87.5%, with 94.7% specificity and 60% sensitivity (n=24, κ -value = 0.58; P-value<0.05). The diagnostic accuracy of T2stage by MRI was 87.5%, with 88.2% specificity and 85.7% sensitivity (n=24, κ-value= 0.69; P-value<0.05). The diagnostic accuracy of T3stage by MRI was 91.7% with 93.3% specificity and 88.9% sensitivity (n=24, κ -value= 0.82; P-value<0.05). The diagnostic accuracy of T4stage by MRI was 95.8%, with 100% specificity and 75% sensitivity (n=24, κ-value= 0.80; P-value<0.05).Conclusion:Because of high accuracy and specificity in determining the depth of invasion of gastric cancer, MRI proves to be an invaluable diagnostic tool in the preoperative T staging of gastric cancer and therefore is very useful in sidestepping unnecessary surgery by supervising the selection of treatment decisions

Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia

@#Introduction: Nurses play a vital role in the care and prevention of ulcers in patients with diabetic foot. Patient education, prevention of ulcers and rehabilitation are some of the vital aspects that nurses provide on a daily basis. Thus, good knowledge and attitude of nurses towards diabetic foot ulcers and its care will ensure better patient care. Objectives: The aim is to study the level of knowledge and attitude of nurses towards diabetic foot ulcers and its care in Hospital Segamat, Malaysia. Methods: A validated questionnaire was used between February 2019 to May 2019 covering area such as demography, predisposing factors of ulcer formation, characteristics of ulcers, complications of ulcers, and attitude towards diabetic foot care. Results: A total of 101 nurses took part and 57% of the participants scored poorly in the knowledge section of the questionnaire. In all 72% had scored poorly when asked regarding complications of diabetic foot ulcers; 49.5% of the nurses had positive attitude towards diabetic foot care; and 79.3% thought that care for diabetic foot ulcer is timeconsuming. Majority of them think that their colleagues are the main source of information. All demographic variables were deemed to be confounders with the knowledge and attitude of nurses towards diabetic foot ulcers and its care. Conclusions: Nurses in this centre had poor knowledge towards diabetic foot ulcers and its care. None of the variable studied were correlated with the level know knowledge. Good or poor knowledge of nurses does not correspond equally to good or poor attitude towards diabetic foot ulcers care. More frequent formal training of diabetic foot care would be needed to ensure better knowledge.

Diabetic foot infection and surgical treatment in a secondary health care centre in Malaysia

@#Introduction: Diabetic foot infection is often associated with high morbidity, disability and poor quality of life. This study focuses on the demography, the number of repetitive surgery and length of stay in hospital of patients with diabetic foot infection. Method: This is a retrospective observational study. Patients who were admitted to the Orthopaedic ward of Hospital Segamat (HS), Johor, Malaysia from January 2016 to December 2018 and required surgical intervention were included in the study. Data was collected from the computer system of HS and medical notes of patients. Results: 35.6% of the total orthopaedic emergency surgeries performed were for patients with diabetic foot infection, 25% of the surgical procedures performed were major amputations of lower limb and 40% of the patients with diabetic foot infection required more than one surgical operation. Discussion: The demographics of the patients is consistent with the demographics of Malaysia where majority of them are Malays followed by Chinese, Indians and others. Despite being only 10% of total admission to the department, this group of patients contributed to 35.6% of the total emergency surgeries performed. The amputation rate in the centre is comparable to the other local studies. The average length of stay in hospital was found to be shorter compared to overseas due to different rehabilitation protocols.

Necrotising fasciitis caused by aeromonas sobria: Not just a simple catfish sting

@#Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.

Level V Clearance in Neck Dissection for Papillary Thyroid Carcinoma: A Need for Homogeneous Studies

Abstract Introduction Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable. Objectives We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival. Data Synthesis The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II-IV or II-V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded. Conclusions The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.

Autologous mononuclear cells from different sources are seen to improve wound healing in patients with haematological malignancies

Introduction: Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival. Background: Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding. Clinical applications of autologous mononuclear cells therapy in wound healing in non-malignant patients with critical limb ischaemia have been reported with remarkable outcome. Methods: We report three patients with haematological malignancies undergoing chemotherapy, who received autologous mononuclear cells implantation to treat non-healing wound after optimum conventional wound care. The sources of mononuclear cells (MNC) were from bone marrow (BM), peripheral blood (PB) and mobilised PB cells (mPB-MNC) using granulocyte colony stimulating factor (G-CSF). The cells were directly implanted into wound and below epidermis. Wound sizes and adverse effects from implantation were assessed at regular intervals. Results: All patients achieved wound healing within three months following autologous mononuclear cells implantation. No implantation adverse effects were observed. Conclusions: Autologous mononuclear cells therapy is a feasible alternative to conventional wound care to promote complete healing in non-healing wounds compounded by morbid factors such as haematological malignancies, chemotherapy, diabetes mellitus (DM), infections and prolonged immobility.

Occlusal splint therapy in the treatment of myofacial pain dysfunction syndrome [MPDS]

The aim of the present study was to compare the hard and soft occlusal splint therapy for the treat-ment of symptoms of temporomandibular myofacial pain dysfunction syndrome [TMPDs] .This study included 50 patients [age range 20-45 years] diagnosed with TMPDs. Patients were divided into two groups for providing hard and soft splints by simple randomization. Group I received vacuum formed Soft while Group II Hard acrylic resin maxillary splints for 6 months. Before treatment and on follow up at 1, 2, 3, 4 and 6 months after treatment, the researcher measured all parameters of TMJ function including mouth opening, pain visual analog scores and tenderness of masticatory muscles .All recorded TMJ function parameters showed statistically significant improvement in both groups during 6 months period.Both hard acrylic and soft rubber splints improved TMPDs symptoms but hard occlusal splints exhibited superior results after 6 months of use

General public perceptions and knowledge on tooth bleaching in Riyadh, KSA

Objective: To assess the perceptions and knowledge on tooth bleaching among general public in 5 different areas in Riyadh, KSA

Method: We assessed a population sample of 300 individuals aged between 15 and 65 years old resident in Riyadh region [2016]. We used frequency distribution and Chi-square test to investigate the association between socio-demographic factors and knowledge/use of bleaching products

Results: The sample is consisted of 66.7% of males and 33.3% of females. 83.3% of the respondents reported knowing bleaching products and advertisements seemed to be the most popular source of information [65.2%]. However only 53.1% reported using bleaching products. Most respondents tried using bleaching products at home [86%], while only 9% undergone tooth bleaching treatment in dental clinics. The commonest reason reported for bleaching was to improve esthetics [66.7%]. Data analysis showed that knowledge of bleaching in Riyadh City is not related to gender, nationality, education and occupation [p >0.05]

Conclusion: Large majority of patients were not happy with the appearance of their teeth, the main complaint being the color. Most of the patients knew that bleaching is a treatment option to improve dental aesthetics, and those who knew only half tried the treatment. More efforts are needed by the dental professions

Surgical outcome of pancreaticoduodenectomy in pancreatic and periampullary neoplasms

Objective: To report the results in the surgical treatment of pancreatic and periampullary neoplasms with emphasis on surgical technique, short-term postoperative outcome and the lessons learnt

Study Design: Case series

Place and Duration of Study: This study was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from October 2014 to May 2016

Methodology: Patients undergoing surgical treatment of pancreatic and periampullary neoplasms were selected. Patients' characteristics including demographics, surgical technique, and 30-day morbidity and mortality were recorded. International Study Group of Pancreatic Fistula [ISGPF] classification was used to define postoperative pancreatic fistula and Clavien-Dindo classification to grade complications

Results: A total number of 65 patients underwent the trial of dissection; 50 had pancreaticoduodenectomy and 15 patients underwent palliative bypass and were excluded from analysis. Sixty-four percent were males and 36% were females. The most common tumor was periampullary [n=29, 58%] followed by pancreatic head [14, 28%] and duodenal tumors [n=07, 14%]. Mean age was 52.92 +/- 13.27 years; mean operating time was 470 +/- 358.28 minutes and median blood loss was 400 [287-500] ml. Pancreaticogastrostomy [PG] was the preferred reconstruction technique in 37 [74%] verses pancreaticojejunostomy [PJ] in 13 [26%] patients. Four [08%] patients needed portal vein reconstruction and two [04%] replaced right hepatic artery resection and reconstruction due to tumor involvement. There were seven Grade A, and one Grade B and C pancreatic fistulae each. Three patients [06%] needed endoscopic therapy for gastrointestinal hemorrhage from pancreatic stump. There was one death in postoperative period

Conclusion: Pancreaticoduodenectomy is a safe procedure with excellent postoperative outcome, if carried out in a specialized hepato-pancreato-biliary unit. A PG reconstruction can be a safer alternative to PJ

Rituximab-induced lung disease

Pulmonary toxicity is a rare complication of Rituximab therapy. Although Rituximab is relatively safe and can be administered in an outpatient setting, Rituximab-associated lung disease has been reported and may cause mortality despite early detection. Typically the pulmonary toxicity occurs at around the fourth cycle of Rituximab. High index of suspicion is crucial and other concurrent pathology such as infective causes should be excluded. Radiological imaging and histological confirmation should be obtained and early treatment with corticosteroid should be initiated. Patients should receive counselling regarding respiratory symptoms and possible pulmonary toxicity.

A case of chronic myeloid leukaemia in blast transformation with leukemic ascites

Chronic Myeloid Leukaemia (CML) is a disease characterised by a distinctive marker that is the Philadelphia Chromosome and an ability to transform into blast phase, which confers a poor prognosis. The median survival was reported to be between three to six months in correlation to blast phase. Extramedullary involvement with CML to sites such as pleural, meningeal and bones have been reported. We report a case of 41-year-old man who was diagnosed with CML in blast phase and presented with ascites. Ultrasound of abdomen showed coarse echotexture of liver suggestive leukaemic infiltration to the liver. The liver profile was severely deranged and associated with coagulopathy. Flow cytometry analysis of the peritoneal fluid revealed presence of myeloblasts consistent with CML in blast crisis with leukaemic ascites. Bone marrow biopsy also confirmed disease transformation. He received standard induction chemotherapy for acute myeloid leukaemia with dose modifications based on liver enzymes performance. Our case highlights an unusual presentation of CML in blast crisis with leukaemic ascites and the challenges in managing cytotoxic treatments due to the liver infiltration.

Diffuse large B cell lymphoma with chronic granulomatous inflammation

Non-necrotic epithelioid granulomas have been reported in association with neoplasms including Hodgkin and non-Hodgkin lymphoma. We report a case of diffuse large B cell lymphoma with chronic granulomatous inflammation to highlight awareness of obscure tumour cells within the granuloma, to avoid delay in diagnosis and management of lymphoma. A 39-year-old Malay lady with no past medical history, presented with a 2-month history of progressive worsening of difficulty in breathing, cough, low-grade fever, loss of weight and loss of appetite. Chest X-ray showed an anterior mediastinal mass and computed tomography (CT)-guided biopsy was reported as chronic granulomatous inflammation suggestive of tuberculosis. After 2 months of anti-TB treatment, her symptoms were not relieved. The patient underwent another CT-guided biopsy of the anterior mediastinal mass in another hospital and the histopathology revealed diffuse large B cell lymphoma. The patient was referred for treatment. On histopathological review, the first sample showed noncaseating granulomas engulfing tumour cells and large abnormal lymphoid cells which were CD20 positive and with high Ki-67 proliferative index. The patient was diagnosed with diffuse large B cell lymphoma stage IV B IPSS score 3. She underwent chemotherapy (R-EPOCH) and responded well to treatmen

Obesity and Hypertension among Christian Religious Subgroups: Pentecostal vs. Orthodox.

Aims: The aim of this study was to determine the impact of religious practices and diet doctrines on obesity and hypertension among Pentecostal and orthodox Christians in the Tamale metropolis. Study Design: This study was a cross sectional study. Place and Duration of Study: This study was conducted between January and June 2014, at the Tamale metropolis, Ghana. Methodology: Three hundred (300) Ghanaian subjects (50.3% Pentecostal participants from the Perez Chapel International and the Church of Pentecost and 49.7% Orthodox participants from the Presbyterian Church and Bethel Methodist Church), 18-72 years of age were recruited for this study. Anthropometric measurements including height, weight, waist and hip circumference as well as blood pressure were measured for each of the study participants. Results: The male participants were taller, heavier with higher mean WHR as well as higher mean SBP as compared to the female participants. The females however, had broader hips as compared to the male participants. The males were more likely to fully comply with the religious prescription on fasting (52.6% vs. 40.7%; p = 0.0397) and diet (30.8% vs. 20.4%; p = 0.0375) as compared to the female. The prevalence of obesity among the population in this study ranged from 17% to 28% depending on the criteria used in the weight classification (i.e. BMI, WHR and WC) and the prevalence of hypertension was 15.0% with no significant difference between both genders. Conclusion: This study highlights the significant increase in the prevalence of obesity and hypertension among both males and female populations, with obesity being more prevalent among females. Compliance to religious doctrines on fasting and or diet does not have an impact on the prevalence of obesity and hypertension from this study.

Prevalence of electrolyte disorders among cases of diarrhea with severe dehydration and correlation of electrolyte levels with age of the patients

Objective: To find out the prevalence of electrolyte disorders among children with severe dehydration, and to study correlation between age and electrolyte, urea and creatinine levels

Study Design: Prospective, analytical study

Place and Duration of Study: Outdoor and indoor of Fazle-Omar Hospital, Rabwah, Pakistan, from January to December 2012

Methodology: All patients from birth to 18 years age, presenting with diarrhea and severe dehydration were included in the study. Urea, creatinine and electrolyte levels of all patients included in the study were checked and recorded in the data form with name, age and outcome. The prevalence of electrolyte disorders were ascertained and correlation with age was determined by Pearson's coefficient

Results: At total of 104 patients were included in the study. None of the patients died. Hyperchloremia was the commonest electrolyte disorder [53.8%], followed by hyperkalemia [26.9%] and hypernatremia [17.3%]. Hyponatremia, hypokalemia and hypochloremia were present in 10.6%, 7.7%, and 10.6% cases, respectively. Weak negative correlation was found between age and chloride and potassium levels

Conclusion: Different electrolyte disorders are common in children with diarrhea-related severe dehydration

Interruption of warfarin before dental surgery

Objective was to find out whether interruption of warfarin before undergoing dental surgery is necessary and to determine the effects of stopping pre-operative warfarin in Patients undergoing minor oral surgical procedures

After taking full medical history, clinical examination and an orthopantogram, randomization was then done by convenience sample technique. A preoperative International Normalized Ratio [INR] and coagulation screen were arranged, with Consent on the day of dental surgery. The group I continued taking warfarin as usual [anticoagulant group]. The group II stopped taking warfarin 2 days before their dental surgery procedure. If a patient's INR was >2, a further dose of warfarin was omitted. The dental surgery was performed under local anesthesia. Oral antibiotic prophylaxis was given for patients at risk of endocarditis in both groups

Two hundred and eighteen patients form the study group. 114 were to the anticoagulant group [Group I] and!04 to the warfarin withdrawn group [Group II]. There were no significant differences between the groups in the mean age, gender, number of teeth extracted. Mean INR for the group I was > 2.5 than the group II, at 1.6 [p=0.001]. The overall rate of bleeding complications in the group I was higher than in the group II [30% compared with 14%]

It is concluded that the minor oral surgical procedures can be done without discontinuing the warfarin

Preventing nerve damage during total thyroidectomy or total lobectomy surgeries

Background and objective: Thyroidectomy is an operation that involves surgical removal of all or part of the thyroid gland. The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury. This study aimed to find out the main postoperative complications particularly nerve damage during total thyroidectomy or total lobectomy

Methods: The medical records of patients who were diagnosed with thyroid disease and underwent surgery between January 2[nd], 2013 and December 30[th], 2014 in Teaching, Shar, Soma and Zhian hospitals in Sulaimaniyah were retrospectively reviewed

Results: All patients who underwent total thyroidectomy or total lobectomy surgeries were discharged within 24 hours of the operation. During the average follow-up of 24 months, no case of permanent recurrent laryngeal nerve injury was registered. Vocal cord paralysis was considered to be present, when there was absent or markedly reduced movement of the affected vocal cord

Conclusions: Meticulous hemostasis and a delicate technique are required to prevent nerve injury. We recommend dissection and division of all the vessels flush with the thyroid capsule at the anterior and peripheral aspect of the gland. Separate ligation of anterior and posterior branched of the superior thyroid artery will preserve the external branch of the superior laryngeal nerves

Nosocomial infective endocarditis in a renal transplant patient: culprit central venous line.

Nosocomial infective endocarditis (IE) is a relatively uncommon but, a serious complication affecting critically ill hospitalized patients who are frequently exposed to life-saving invasive procedures. Immunosuppressive treatment in solid organ transplant recipients predisposes to infections, nevertheless, nonspecific symptoms of IE, such as fever, lassitude, weight loss, and signs of inflammation may often be misinterpreted as acute rejection episode or a common urinary tract infection. The case reported here was a recent renal transplant with methicillin-resistant Staphylococcus aureus IE. We believe the diagnoses of IE in her were missed at her first presentation due to her non-specific symptoms and lack of echocardiography and blood culture results. Septic procedure at insertion of central venous catheter (CVC) in the Intensive Care Unit with trauma to tricuspid valve (TV) at the time of CVC insertion was a possible source of infection for IE. The patient was managed effectively with intravenous antibiotics in spite of having hanging pedunculated vegetation on TV.