Journal of Medical Case Reports and Reviews

Performance of quality of life related to oral health in the staff of the Shahid Beheshti Dental School

Shiva rivandi — 2024-06-04

Background: Health workers are considered as an important part of society and a role model for service recipients. Quality of life related to oral health is a common concept to assess the impact of oral conditions and the impact of dental interventions that affect people in many aspects such as physical, mental, social and ability to perform daily activities of life.

Objective: The aim of this cross-sectional study is the performance of quality of life related to oral health in the staff of Shahid Beheshti Dental School.

Methods: This study was performed on 85 employees of Shahid Beheshti Dental School in 2021. Participants in the study completed a quality of life questionnaire related to oral health (OHIP-49). Data by regression method, T, ANOVA and Mann-Whitney tests were analyzed by SPSS 24 statistical software.

Results: The mean total score of Oral Health Impact Profile (OHIP) in the staff of Shahid Beheshti Dental School was 25.5 with a standard deviation of 26.8. The most problematic subscale was primarily the subscale of physical pain with an average score of 7.6 and then the subscale of functional limitation with an average score of 6.5. On the other hand, the least problem area was the subscale of social disability, with an average score of 1.3. According to the data analysis, the main problem of participants in the field of physical pain is the sensitivity of their teeth when using hot or cold food and beverages (3.5%). Most people (7.1%) have noticed that the appearance of their teeth may not be correct, which is on the subscale of functional limitations. 83.5% of the participants had never had a problem in communicating with others due to their dental problems, which was the lowest problem in the field of social disability. There was no relationship between the mean OHIP score and the measured demographic variables, including age, sex, marital status, level of education, and chronic disease.

Conclusion: The results of the study showed that the quality of life related to oral health in dental staff has an acceptable performance.

Keywords: OHIP-49, quality of life, oral health

Dr When you hear hoofbeats sometimes it's Zebra

Akhil Deshmukh — 2024-06-04

In medicine, the term "zebra" is used for a rare disease or condition, like neuroendocrine tumors (NET). Medical students are thought to assume that the simplest explanation is usually the best, i.e., it is usually correct to look for common rather than exotic causes for the disease. Doctors learn to expect common conditions, hence the riddle “If you hear hoofbeats, think horses, not zebras.” But zebras do exist, and the unlikely NET can and does sometimes occur. NET is often presented with symptoms of far more common illnesses such as Crohn’s Disease, irritable bowel syndrome, asthma, and rosacea. When diagnosing patients who present with varying symptoms, we doctors need to remember that when they hear hoofbeats it could also be a Zebra. This is a case of a 56yr female presenting with diarrhea. On evaluation, she was found to have a pancreatic tumor with metastasis to the liver. Biopsy from the hepatic metastasis confirmed neuroendocrine carcinoma and diarrhoeal episodes decreased with octreotide. Further treatment options were explored and started on cisplatin-etoposide-based chemotherapy.

30-Day Readmission Rates Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analyses

Marjan Hesari — 2024-06-04

Abstract

Study design: a systematic review

Objectives: The 30-Day readmission and reoperation rates after traumatic spinal cord injury (SCI) is reviewed systematically.

Methods: We systematically reviewed the literature published from Jan. 1990 to July. 2021 via PubMed, Cochrane, and EMBASE. Our primary outcomes were the overall proportion of 30-day readmission following traumatic SCI during the index admission, and inpatient rehabilitation facilities.

Results: A two-phase screening process was conducted by independent reviewers; eight articles met the eligibility criteria for our study. The findings showed that the proportion of readmission following index admission was 15% (95% CI, 13 - 18). Furthermore, 30-day readmission rates following rehabilitation facilities were 7% (95% CI, 3 - 15). There was no difference between the pre-and post-sensitivity pooled readmission proportion. There was no evidence of potential small-study effects based on Egger's test.

Conclusions: There is no doubt that readmission is an adverse health outcome. The outcome is also complex and multifaceted, which makes it difficult to predict. Injury level is one of the predictors that affect readmission, making it essential to consider factors during discharge planning for high-risk people to reduce 30-day readmission rates.

Comparison of Unilateral Total Knee Replacement versus simultaneous Bilateral Total Knee Replacement

saifullah soomro — 2024-06-04

Background: Total knee replacement (TKR) is a procedure that is often performed on patients who have advanced osteoarthritis and has become more common. Bilateral TKR can be done at the same time and can save time, anesthesia and cost of multiple procedures.

Objective: To determine the frequency of unilateral and simultaneous bilateral Total Knee Replacement and then compare their outcomes

Study Design: Cross sectional study

Study place: Orthopedics Department; Chandka medical college Larkana, Sindh, Pakistan, where arthroplasty services have been recently started.

Study period: 12 months after approval of synopsis

MATERIAL AND METHODS: 95 patients were included and were divided in two groups i.e. patients undergo unilateral TKR were grouped as group A and patients undergo bilateral TKR were grouped as group B. Then patients underwent surgery under general anesthesia. All patients were followed-up in OPD. During follow-up, patients were evaluated for outcome i.e. cardiac event, urinary tract infection and surgical site infection. All this information was recoded on proforma while analysed in SPSS v. 22. Outcome was compared in both groups by using chi-square test. The P-value≤0.05 was considered as significant.

Results: The mean age of patients was 63.00 ± 6.17 years. There were 50 (52.6%) males and 45 (47.4%) females. The mean BMI of females was 27.93 ± 2.43 kg/m². There were 47 (49.5%) patients who underwent simultaneous bilateral surgery while 48 (50.5%) underwent unilateral surgery. It has been observed that after surgery, the cardiac event occurred in one (1.1%)case and that case was from unilateral surgery group, urinary tract infection occurred in 4 cases, 2 (4.3%) were from bilateral cases while 2 (4.2%) were from unilateral group and surgical site infection occurred in 4 cases, 2 (4.3%) were from bilateral cases while 2 (4.2%) were from unilateral group. The difference was insignificant in both groups (p>0.05).

Conclusion: Thus there was no significant difference observed between both groups regarding complications after surgery.

Key words: Bilateral, cardiac event, knee osteoarthritis, surgical site infection, total knee arthroplasty, unilateral, urinary tract infection

Patients Misunderstanding of Dosage Instructions among Patients attending Kenema Pharmacy: Do Pharmacists ask ‘Tell me so I know you understand?’

mende sorato — 2024-06-04

Background: Despite the advance in drug development and availability of dozens of drugs in the healthcare system today, knowledge of patients about dispensed medicines is poor to the extent suppositories are being swallowed by patients. The size of commonly used paper envelopes for labeling in Ethiopia doesn't even allow writing the required drug information on it.

Methods: Direct observation supported cross-sectional study was conducted to assess the extent of patients' misunderstanding of dosage instructions and associated factors among patients attending Kenema Pharmacy Number 09 at Addis Ababa by using a pre-specified structured interview questionnaire.

Result: A total of 398 patients were included in the study and 62.81% were female. Around 34.42% of respondents were found to be in the age range of 25 to 34 years. Two hundred eighty-eight (72.36%) of participants misunderstood one or more dosage regimen instructions, and 269(67.59%) misunderstood the frequency of drug administration. The most commonly misunderstood medications were antibiotics. Moreover, from medication label observations, 273 (68.25%) were dispensed without a medication label. Patient misunderstanding of dosage instructions was significantly associated (p< 0.001) with age, residence, and educational level.

Conclusion: A significant number of patients misunderstood dosage regimen instructions. The majority of drugs were dispensed without label information and pharmacists did not practice the 'tell me back if you know, principle to ensure understanding of communicated information. Age, educational status, sex, and residence of patients were significantly associated with patient misunderstanding of dosage instructions. Therefore, pharmacy professionals should appropriately label, and effectively communicate to ensure patient understanding of the dosage instructions for the patient before dispensing. Future studies involving multiple sectors should be done to identify the ranges of associated factors with patients' misunderstanding of dosage instructions and patient–dispenser communication optimization.

A case series of secondary Hemophagocytic Lymphohistiocytosis in the critical care patients

Grettel Gonzalez Garcia — 2024-06-22

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition associated with fever, cytopenia, hepatomegaly and hemophagocytes caused by activated macrophages. HLH can be primary (familiar) or secondary (acquired), and it is diagnosed when patients meet at least 5 out of 9 diagnostic criteria (fever, splenomegaly, cytopenia, hypertriglyceridemia, low fibrinogen, hemophagocytes, low natural killer cells activity, elevated ferritin and CD25 cells) or Confirmation of an HLH-associated genetic mutation. We present a case series of 3 patients with HLH syndrome likely secondary to infections and rheumatologic conditions, requiring critical care level of care due to their worsening clinical status requiring aggressive management and advanced therapies, representing a diagnostic challenge due to its similarities with multiple other diseases (e.g. macrophage activation syndrome, Still disease, disseminated intravascular coagulation). High clinical suspicion and knowledge about the syndrome are key players when managing these types of patients, because even if we treat the cause (infections, and other conditions as mentioned above), they might require additional medication such as high dose steroids and immunomodulators like anakinra.

Fortunately, success was achieved for all the patients represented in this case series. They were treated for their primary diagnosis likely causing HLH plus the additional therapeutic support, since this is a very rare condition and each case presented within a few months difference, they were able to be diagnosed quickly enough so the proper individualized treatment was applied.

Peculiarities of anesthesia in endoscopic surgical transnasal transsphenoidal approach for removal of pituitary adenoma

nasibova esmira mirza — 2023-08-10

The endoscopic endonasal transsphenoidal approach to pituitary adenomas is gaining increasing popularity as an alternative to the traditional technique using an operating microscope. Although discussions are still ongoing about the superiority of the endoscopic approach over the microscopic approach in terms of completeness of resection, which is especially important for macroadenomas, endoscopic access offers advantages in assessing nasal function and degree of disability.